One of the foundations of President Obama's Patient Protection and Affordable Care Act (ACA) is the active encouragement of patient-centered, data-based interprofessional (i.e., interdisciplinary) integrated care models to be established within comprehensive systems of care, such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes. In many ways, the envisioned clinical structures are very similar to President Nixon's HMOs and President Clinton's Managed Care initiatives, of which organized psychology has historically been less than supportive. The ACA provides for a priority on preventive care and eliminating traditional barriers to receiving mental health and behavioral health care. The all-important psychosocial-cultural-economic gradient of care is to be systematically encouraged. We would suggest, however, that in order to successfully function (if not thrive) within this exciting evolving environment, it would be very helpful for our educators and clinicians to become intimately familiar with the training, orientation, and clinical skills of the other health care professions – not to mention developing a public health perspective.
Under the leadership of visionary APA Past President Nadine Kaslow, the Council of Representatives voted last year to encourage psychology's training programs to affirmatively embrace Competency-Based training. In 2007, Nadine opined: "Professional psychology is moving towards competency-based models with attention to competency-based education, training, and credentialing." In 2009, six national schools of health professions education associations formed the Interprofessional Education Collaborative (IPEC) in order to promote and encourage efforts to advance substantive interprofessional learning experiences with the goal of preparing future clinicians for the team-based care of patients. The IPEC collaborative partners are the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools and Programs of Public Health. APA cannot be one of the core groups as it is not an association of schools/programs; nevertheless, the Education Directorate has been working closely with IPEC.
From a health policy perspective, it is significant that whereas one of the required competencies for our colleagues in nursing is Health Policy (including teaching their next generation how to become actively involved in the political process), this is not the case for psychology's training programs. In fact, a review of psychology's literature found very few training programs offering any relevant courses or "hands-on" training experiences. The one notable exception is APA's Congressional (and now also Executive) Fellowship program which celebrated its 40th anniversary last year, having provided this transformative experience for 119 colleagues.
The former Speaker of the U.S. House of Representatives Tip O'Neill noted that "All politics is local." Described slightly differently by former APA Congressional Fellow Neil Kirschner: "More often than not, research findings in the legislative arena are only valued if consistent with conclusions based upon the more salient political factors…. If I've learned anything on the Hill, it is the importance of political advocacy if you desire a change in public policy." Having personally served on the U.S. Senate staff for 38+ years, I would suggest that the key to effective advocacy is developing quality personal relationships with one's elected officials and their staff over a prolonged period of time. The most common professional background of elected officials has consistently been law, followed by business. Most obtain their health care knowledge from personal or family experiences or through the popular media. To assume they are aware of the nuances of health care or of the extent of psychology's training and thus potential contributions, would be extremely naïve.
To become an effective advocate for one's cause (including for one's profession) one must be present, possess patience and persistence, and be committed to the long haul. It is definitely helpful to develop an appreciation for how one's legislative or administrative agenda fits into a larger societal context. Has the time arrived for the changes you desire and are there any natural allies for what you propose? What, for example, might be the priorities of the newly elected Republican controlled Congress? The ACA currently places much of the responsibility for implementation of the broad underlying statute at the local and state level. Unfortunately, as drafted, psychology is not expressly enumerated under the ACO or Medical Home provisions of the law, although the clinical services psychology could provide are clearly possible if local administrators or policy makers so desire. Similarly, the details of the various state Medicaid programs (which form the underlying basis for the ACA's expansion of health coverage for 32 million Americans) are also determined at the state level, where once again, unfortunately, psychology has generally been silent.
When meeting with one's elected officials and/or their staff, visits to their home office, especially during a Congressional recess, can be highly productive. Those colleagues who are fortunate to be invited to the APA Practice Directorate's exciting annual State Leadership Conferences, will receive "hands-on" training regarding psychology's national agendas, as well as experience "mock-visits" with an elected one. However, as the former Speaker of the House noted, local is best. To arrange such a meeting, simply call their local offices. One does not need detailed briefing materials or a comprehensive agenda. Their job is to make you comfortable. If requested, APA will provide background information as well as their legislative priorities. Professor John Linton knows the APA governance and can be an excellent advisor, as can your State Association. Being present is the most important ingredient.
Congress is organized every two years within a committee/subcommittee structure with those elected gravitating to areas that personally interest them. Your job is to explore how they can be most helpful to your broader agenda, based upon their committee assignments. When I think of West Virginia psychology, I warmly reflect upon the tireless dedication of Tom Stein. Psychology's successful inclusion in Medicare was a prolonged journey, significantly influenced by Tom's vision and dedication. For over a decade, I could see Tom's colorful map of West Virginia – highlighting the accessibility of psychology – on Senator Rockefeller's wall. Psychology's true Medicare champion. Aloha,
Pat DeLeon, former APA President – West Virginia Psychological Association – January, 2015
