For our nation's health care professionals, these are very "interesting" times. Change is always unsettling, especially when it is difficult to predict with any sense of certainty what the future will bring. Under the visionary leadership of APA President Nadine Kaslow, the Council of Representatives endorsed moving towards Competency-Based Education, an approach which has been adopted by nearly every other health care profession. At the end of last year, the Accreditation Council for Pharmacy Education, Commission on Collegiate Nursing Education, Commission on Dental Accreditation, Commission on Osteopathic College Accreditation, Council on Education for Public Health, and the Liaison Committee for Medical Education formed the Health Professions Accreditors Collaborative (HPAC). They are committed to discussing important developments in interprofessional education and exploring opportunities to engage in collaborative practice around the common goal of better preparing students to engage in interprofessional collaborative practice. They anticipate inviting other disciplines to join their effort later this year in response to inquiries.
If one reviews the training models of the other health professions, there is considerable interest (especially within nursing and public health) in exposing their next generation of practitioners to the nuances and importance of appreciating health policy – and how, for example, over the past decade various health policy experts have increasingly urged the nation to emphasize developing systems of care, rather than continuing to rely upon individual practitioner expertise. Unfortunately, we have observed that such training is relatively rare within psychology's training programs. Integrated and patient-centered, data-driven holistic primary care provided by interprofessional teams is one of the cornerstones of President Obama's Patient Protection and Affordable Care Act (ACA). And, it has clearly been a high personal priority for U.S. Army Surgeon General Patty Horoho during her tenure.
Those colleagues trained in providing mental health and/or behavioral health care face significant challenges in effectively addressing our nation's pressing needs. On a recent HRSA national advisory committee conference call it was noted: "Mental health disorders rank in the top five chronic illnesses in the U.S. An estimated 25 percent of U.S. adults currently suffer from mental illness and nearly half of all U.S. adults will develop at least one mental illness in their lifetime. In 2007, over 80 percent of individuals seen in the emergency room (ER) had mental disorders diagnosed as mood, anxiety and alcohol related disorders."
At the Uniformed Services University of the Health Sciences (USUHS), nursing and psychology are pursuing ways to systematically share expertise. A number of courses are jointly taught and/or co-attended; e.g. Stress and Trauma in the Military Context, Introduction to Physiology, and Health Policy. Mental health students enrolled in both training programs (Doctor of Nursing Practice/Clinical and Medical Psychologist) regularly utilize the university's simulation lab where live actors "play out" various symptomology for the trainees, while monitored on closed circuit television. Discussions are currently underway to facilitate cross-professional critiques of these experiences. An underlying question: Why should there be different training models?
A Very Far Reaching Vision: In January of this year, the Military Compensation and Retirement Modernization Commission, a blue ribbon panel established by Congress in 2013, submitted its 302-page Final Report to the Administration and Congress. Even a cursory review provides a sense of the unprecedented magnitude of their recommendations. "Our volunteer Service members are the strength of our military, and it is our continuous duty and obligation to ensure that the Services are properly resourced…. In considering the military health benefit, we focused on sustaining medical readiness by recommending a new readiness command, supporting elements, and framework for maintaining clinical skills….
"The critical nature of joint readiness, including the essential medical readiness… make it clear that four-star leadership is needed to sustain dedicated focus on the joint readiness of the force. Ensuring that the hard-fought progress achieved during the past decade in the delivery of combat casualty care on the battlefield, the global capability for evacuating casualties and providing critical care while in transit, and the research that has led to advances in wound care and hemorrhage control, requires strong oversight at the highest level. The Commission thoroughly evaluated the merits of a four-star joint medical command…. (M)edicine is only one component of joint military readiness. The essential nature of military medicine by itself warrants four-star oversight, and the Commission concludes the best course of action is to create a four-star Joint Readiness Command to manage the readiness, as well as the interoperability, efficiency, and 'jointness' of the entire military force, including medical readiness….
"Health care is a constantly changing industry. The features of health care, including technology and the models for paying for and delivering care, rapidly evolve. Rather than attempting to replicate a private-sector health care system within DoD, and consequently following behind, the Commission believes beneficiaries would be better served by having direct access to the innovations found in private-sector health care. Furthermore, under commercial insurance, carriers have the tools, including the advancements in payment and delivery models… and the monetary and nonmonetary incentives… to increase value by operating more efficiently." 'Cause I'm leavin' on a jet plane. Don't know when I'll be back again. Aloha,
Pat DeLeon, former APA President – Division 19 – February, 2015
