Division 19 May, 2015 column

A VISION FOR THE FUTURE

            The U.S. Army Surgeon General:  With her tenure coming to a close, the U.S. Army Surgeon General Patricia Horoho testified this spring before the Senate Appropriations Committee.  In the history of our nation, she is the first female and first non-physician Surgeon General of any of the military services and brings with her a refreshing vision regarding the critical importance of focusing upon the whole soldier and his/her family.  She appreciates the importance of transforming “Army Medicine from a healthcare system to a System for Health” and the clinical significance of the reality that “The patient healthcare encounter to be an average interaction of 20 minutes, approximately five times a year.  Therefore, the average 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.”

            After the fall election, the Congress has continued, if not intensified, its interest in significantly curtailing federal budget expenditures.  During this year’s Senate testimony SG Horoho expressed her “grave concerns essential programs for rebuilding our Soldiers after over a decade of conflict will take the brunt of these cuts.  The impacts will be visible in decreased resources to sustain initiatives in Behavioral Health (BH) and Traumatic Brain Injury (TBI); a decrease in access to care; and extended appointment times for our Soldiers, Families, and Retirees at our health readiness platforms.  MEDCOM would reduce research and training programs throughout the Command to ‘must-fund’ levels.  This will significantly reduce progress that has been made in medical programs over the last few years both in the areas of research and training of the force.”  As we indicated in our previous discussion of the recommendations contained in the 2015 report to Congress by the Military Compensation and Retirement Modernization Commission, a blue ribbon panel established by Congress in 2013, there has been increasing pressure on the Administration to privatize those governmental functions where cost-effective savings might be achieved.  From our public policy and historical perspective, military health care and related human service resources represent prime targets.  Why, for example, could not the private sector provide higher quality health care CONUS for military personnel, their families, and retires rather than continue to invest in DoD or VA systems?  These are serious institutional challenges and we understand that many at the highest level of federal health care leadership have been “pushing back” against this argument.  It does represent, however, a longstanding debate on the fundamental role of government – way beyond healthcare, health professions training, and behavioral research.

            “Army medicine is so much more than a civilian healthcare system; we are national leaders in medicine, dentistry, medical research, education, and training, and public health….  Over the last few years, we have made great strides in improving the health readiness of the force, leading Army’s cultural change towards a more ready and resilient Soldier.  This success was achieved by promoting the Performance Triad, comprised of healthy sleep, activity, and nutrition, and increasing the impact of our readiness touch points to include embedded providers….  Our medical force has remained ready and deployable, leveraging lessons learned in theater to improve care in garrison, and using evidence-based practice and cutting edge research to improve care delivered far forward….  However, Army Medicine is keenly aware of the unique stressors facing Soldiers and Families today, and continues to address these issues on several fronts.  Taking care of our own – mentally, emotionally, and physically – is the foundation of the Army’s culture and ethos, and is unquestionably an enduring mission….  The Army is removing the stigma associated with seeking BH care with programs such as Embedded BH (EBH) that provides targeted care in close proximity to Soldiers’ unit areas and in close coordination with unit leaders.”

            A Sister Service:  This spring I had the opportunity to attend the U.S. Public Health Service 72^nd year Cadet Nurse Corps Recognition Ceremony – Honoring their Legacy to Nursing.  The former Acting USPHS Surgeon General Boris Lushniak presented an inspiring tribute, quoting their Pledge – “I will keep my body strong, my mind alert, and my heart steadfast; I will be kind, tolerant, and understanding….  As a Cadet Nurse, I pledge to my country my service in essential nursing for the duration of the war.”  The same message, decades later, Lt. General Horoho has been delivering.  I also had the pleasure of attending the first USUHS Department of Psychology Dining Out dinner, honoring the students who will soon be on their way to their internships, championed by acting chair Jeff Quinlin.  Another wonderful tribute.

Yet, it is important to appreciate that journeys continue.  During our USUHS interdisciplinary health policy class, Ingrid Pauli, who played an active role during the USPHS response to the most unfortunate Navy Yard shooting, reminded those present that although they may really excel at clinical work, as military advanced practice nurses and psychologists they must expect to be called upon to demonstrate administrative leadership.  Throughout one’s career, one should reflect upon what the future might bring.  A recent publication provides an intriguing perspective.   How We Built Our Dream Practice – Innovative Ideas for Building Yours by David Verhaagen and Frank Gaskill shares a very interesting and thoughtful vision.  One critical message – Enjoy your strengths and inner priorities.  Decide to work with colleagues who share these same fundamental values.  In the long run, you will best be served.  Aloha,

Pat DeLeon, former APA President – Division 19 – May, 2015

 

A VISION FOR THE FUTURE

The U.S. Army Surgeon General:  With her tenure coming to a close, the U.S. Army Surgeon General Patricia Horoho testified this spring before the Senate Appropriations Committee.  In the history of our nation, she is the first female and first non-physician Surgeon General of any of the military services and brings with her a refreshing vision regarding the critical importance of focusing upon the whole soldier and his/her family.  She appreciates the importance of transforming "Army Medicine from a healthcare system to a System for Health" and the clinical significance of the reality that "The patient healthcare encounter to be an average interaction of 20 minutes, approximately five times a year.  Therefore, the average 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."

            After the fall election, the Congress has continued, if not intensified, its interest in significantly curtailing federal budget expenditures.  During this year's Senate testimony SG Horoho expressed her "grave concerns essential programs for rebuilding our Soldiers after over a decade of conflict will take the brunt of these cuts.  The impacts will be visible in decreased resources to sustain initiatives in Behavioral Health (BH) and Traumatic Brain Injury (TBI); a decrease in access to care; and extended appointment times for our Soldiers, Families, and Retirees at our health readiness platforms.  MEDCOM would reduce research and training programs throughout the Command to 'must-fund' levels.  This will significantly reduce progress that has been made in medical programs over the last few years both in the areas of research and training of the force."  As we indicated in our previous discussion of the recommendations contained in the 2015 report to Congress by the Military Compensation and Retirement Modernization Commission, a blue ribbon panel established by Congress in 2013, there has been increasing pressure on the Administration to privatize those governmental functions where cost-effective savings might be achieved.  From our public policy and historical perspective, military health care and related human service resources represent prime targets.  Why, for example, could not the private sector provide higher quality health care CONUS for military personnel, their families, and retires rather than continue to invest in DoD or VA systems?  These are serious institutional challenges and we understand that many at the highest level of federal health care leadership have been "pushing back" against this argument.  It does represent, however, a longstanding debate on the fundamental role of government – way beyond healthcare, health professions training, and behavioral research.

            "Army medicine is so much more than a civilian healthcare system; we are national leaders in medicine, dentistry, medical research, education, and training, and public health….  Over the last few years, we have made great strides in improving the health readiness of the force, leading Army's cultural change towards a more ready and resilient Soldier.  This success was achieved by promoting the Performance Triad, comprised of healthy sleep, activity, and nutrition, and increasing the impact of our readiness touch points to include embedded providers….  Our medical force has remained ready and deployable, leveraging lessons learned in theater to improve care in garrison, and using evidence-based practice and cutting edge research to improve care delivered far forward….  However, Army Medicine is keenly aware of the unique stressors facing Soldiers and Families today, and continues to address these issues on several fronts.  Taking care of our own – mentally, emotionally, and physically – is the foundation of the Army's culture and ethos, and is unquestionably an enduring mission….  The Army is removing the stigma associated with seeking BH care with programs such as Embedded BH (EBH) that provides targeted care in close proximity to Soldiers' unit areas and in close coordination with unit leaders."

            A Sister Service:  This spring I had the opportunity to attend the U.S. Public Health Service 72^nd year Cadet Nurse Corps Recognition Ceremony – Honoring their Legacy to Nursing.  The former Acting USPHS Surgeon General Boris Lushniak presented an inspiring tribute, quoting their Pledge – "I will keep my body strong, my mind alert, and my heart steadfast; I will be kind, tolerant, and understanding….  As a Cadet Nurse, I pledge to my country my service in essential nursing for the duration of the war."  The same message, decades later, Lt. General Horoho has been delivering.  I also had the pleasure of attending the first USUHS Department of Psychology Dining Out dinner, honoring the students who will soon be on their way to their internships, championed by acting chair Jeff Quinlin.  Another wonderful tribute.

Yet, it is important to appreciate that journeys continue.  During our USUHS interdisciplinary health policy class, Ingrid Pauli, who played an active role during the USPHS response to the most unfortunate Navy Yard shooting, reminded those present that although they may really excel at clinical work, as military advanced practice nurses and psychologists they must expect to be called upon to demonstrate administrative leadership.  Throughout one's career, one should reflect upon what the future might bring.  A recent publication provides an intriguing perspective.   How We Built Our Dream Practice – Innovative Ideas for Building Yours by David Verhaagen and Frank Gaskill shares a very interesting and thoughtful vision.  One critical message – Enjoy your strengths and inner priorities.  Decide to work with colleagues who share these same fundamental values.  In the long run, you will best be served.  Aloha,

Pat DeLeon, former APA President – Division 19 – May, 2015

 

Division 29 May, 2015 column

I SAW HER AGAIN LAST NIGHT….

            The Very Best of APA:  The annual APA Practice Directorate State Leadership Conference (SLC) continues to be the highlight of my APA year.  This spring 530 colleagues, including an impressive number of early career psychologists and first time attendees, were treated to another spectacular event.  New models of service delivery, the importance of integrated and patient-centered care; and focusing upon developing effective business plans, while simultaneously providing “value-add” were highlighted.  The Illinois Psychological Association’s recent prescriptive authority success, thanks in large part to the dedication and persistence of Beth Rom-Rymer, brought new life to the RxP movement with a number of states reporting their membership being re-energized.  Ann Compton, former White House correspondent for ABC News presented a fascinating perspective on the inner workings of the Oval Office, when Hillary would finally announce, and the unique perspectives of the First Ladies.  This was also the 10^th anniversary of David Ballard’s visionary Psychologically Healthy Workplace and Organizational Excellence Awards ceremony, which actively engages psychology with the best of the business community at both the local and national level.  Under Norman Anderson’s leadership, APA itself was recently designated as one of the “Best Places to Work” by the Washington Post.  As always, the enthusiasm and excitement of the audience was palpable.

            The theme for this year’s conference was Practice Innovation and Practice Directorate Executive Director Katherine Nordal challenged those present to step up and become visionary leaders.  “Innovation involves new ideas and processes, change, upheaval and transformation.  To be innovators we need to shake off some old ways of thinking about traditional practice models.  We also need to shake off the negative attitudes some of our colleagues have about what’s happening in health care.  The world is changing and health care is moving ahead – with or without psychology.  Whether we move forward will be up to us!  We need to think differently about our professional roles and the way we provide services.  Too many psychologists are stuck in the traditional 50-minute therapy box.  And that box is way too confining.  We need to think creatively… how we practice… where we practice… and what we practice.

            “How can psychologists participate in the evolving system in ways that are good for us, our profession and our patients?  What effects will reforms in health care systems, financing and technology, have on us?  And, how do we, as leaders in our profession, support our members as these changes unfold?  We need to see and understand the bigger picture – the health care environment in which psychology lives.  Psychology should be the discipline that defines and expands the mental health quality measures available for Medicare and other public and private payers as these measures become more widely required.

“Clinical practice guidelines provide an example of our asserting a leadership role.  Historically, psychology has not been at the table.  That has enabled others to control the process, and payers have used their guidelines to determine what they will and will not pay for.  That will change as APA finalizes three initial guidelines – for PTSD, depression and obesity.  Guidelines developed by other disciplines often ignore the rich psychological science that informs good practice.  APA guidelines will identify the most effective psychological treatments for these disorders, regardless of the discipline providing the care.  Our guidelines development process is innovative.  APA’s panels are multidisciplinary.  One of our cutting-edge, best practices is including community members on each panel to represent the patient perspective.

“You’ll need a dose of courage to face the resistance you’re going to encounter back home.  There will be times when your colleagues push back at your efforts at innovation.  Sometimes you’ll hear your colleagues complain, ‘We shouldn’t change the way we’ve always done it.’  Or, ‘That’s not how I was trained.’  When you get that push back, what 3-word message are you going to give back to them?  ‘Shake it off.’  You are the leaders with the focused vision and vigilance needed to influence a challenging, changing health care system.  You are the leaders who will shape a vibrant future for professional psychology.”

The Administration’s Vision:  At a recent HRSA national Advisory meeting, the acting administrator discussed the Accountable Care Act’s vision for improving access to quality care; fostering a more diverse workforce emphasizing team-based, interdisciplinary care; developing healthy communities (i.e., a population-based focus); and giving a priority to prevention ,while addressing historical health disparities.  This is Katherine’s charge.

            A Very Special Personal Journey:  “The APA Congressional Science Fellowship program had a profound impact on my life and my career, and I am profoundly grateful for the experience.  At the most recent APA Council of Representatives meeting, former Congressman Brian Baird gave a talk at the plenary session and commented on the importance of the Fellowship for both the profession of psychology and for Congress itself.  You might recall that I was the first psychologist to be a Robert Wood Johnson (RWJ) Health Policy Fellow, and this predictably led to ‘Potomac Fever.’  I loved working on the personal staff of Senator Tom Daschle, and cherish the time I spent with Tom (in both South Dakota and DC) and being mentored by Rima Cohen, his health policy legislative assistant.  Of course, the two-month Institute of Medicine (IOM) orientation helped too (e.g., our half-day lecture about and tour of HHS was given by then Secretary Lou Sullivan).  I wrote lots of speeches, drafted legislation, met with constituents, attended committee hearings, and was intimately involved with the reauthorization of funding for the National Health Service Corps.  Bob Frank was the second psychologist picked as an RWJ Fellow; I’m sure his time working for Senator Jeff Bingaman (D-NM) at least partially was responsible for his current position as President of the University of New Mexico.

“Realizing that I could never go back to running a neuropsychology lab, I resigned a tenured full professorship at the Marshall University School of Medicine, determined to reshape my life as a health policy maven.  I applied for both the APA Congressional Science Fellowship and the MPH program at Harvard.  I was accepted for both, but opted to stay in DC and continue to learn about the fascinating world of health policy.  Ted Kennedy, Jay Rockefeller and Pete Stark all offered me jobs on their personal staff, but Congressman John Conyers then chaired the House Government Operations Committee, and I accepted a position on his committee staff, in part because of my interest in promoting a Canadian style single payer health care system for the United States, something Congressman Conyers passionately supported.  In addition, after a year working in the Senate, I wanted to learn more about the House of Representatives.

            “While spending two years on the Hill, I had an opportunity to get actively involved with APA activities and operations (Fellows are invited to participate in almost all relevant APA conferences, meetings, events and summits).  This eventually led to my active participation in APA governance and presidency of three divisions (12, 46, and 52) as well as participation for several terms on the Council of Representatives.  During this second year working for the Congress, my former Dean at Marshall became the Dean of the School of Medicine at the University of Missouri.  Although a thoracic surgeon, this Dean was very psychologically minded, and he was determined to bring me back to the Academy.  He offered me an opportunity to direct the Missouri Institute of Mental Health (MIMH), a policy, research and training ‘think tank’ with over 100 employees and a budget of about $6 million.  MIMH operated at the interface of the University of Missouri and the Missouri Department of Mental Health, and our mission was to serve anyone in Missouri with a mental illness, addiction or developmental disability.  The job required lots of time in Jefferson City (the state capital) as well as tracking state legislative policy.  It was a job that wouldn’t come around again, so I accepted the Dean’s offer and happily spent the next 20 years running the Institute.  I never went back to being a neuropsychologist… but I never regretted making the shift from direct patient care to being a ‘policy wonk.’

            “I simply couldn’t have done the job at MIMH – and it would never have been offered – had I not spent time on the Hill as a congressional science and health policy fellow.  I like to think I made a real difference during the two decades I spent in Missouri, and I’ve had opportunities to introduce literally thousands of students to health policy issues, both in Missouri and while serving as an Associate Dean at the California School of Professional Psychology (CSPP).  I also make sure the medical students I’m now teaching at the American University of Antigua know something about how health policy is shaped and how profoundly their professional lives will be affected by what happens in the halls of Congress and in state legislatures.  (A fortuitous and entirely unexpected benefit of being a former APA/AAAS Fellow was being invited to Canberra to testify before a subcommittee of the Australian Parliament about my experiences working on the Hill.)  Our 40^th Congressional Science Fellowship anniversary celebration at our last convention was truly memorable” [Danny Wedding].

            Change Is Inescapable; Although It Does Take Time:  As Katherine so apply notes, a number of our colleagues appear to be intractably resistant to change.  Apparently, however, this fundamental orientation is not limited to the discipline of psychology.  In reading about Rear Admiral Grace Hopper, who was a pioneering computer specialist, and who retired in 1986 as the Navy’s oldest serving officer (having served for 42 years), I smiled learning: “In general, applied mathematicians were looked down on by their colleagues in pure mathematics.  There was a widespread belief that ‘you turned to applied mathematics if you found the going too hard in pure mathematics.’”  Thank goodness for colleagues like former Division and APA President Ron Fox who continues to press for change, now meeting almost monthly with APA’s Heather Kelly strategizing about how to get psychologists -- who are themselves veterans -- to insist that they should continue to have access to the services of prescribing psychologists within the VA, as they did while on active duty.

Former USAF Prescribing Psychologist Elaine Foster recently wrote her own elected official: “After graduating from the DoD Psychopharmacology Demonstration Project (PDP) I served as a prescribing psychologist in the Air Force for over 20 years.  I continued to serve our active duty military after retiring, again as a prescribing psychologist under contract with the Air Force.  During that time, I prescribed for our veterans when we had space available at our military clinic….  If I walked across the hospital parking lot to our annexed VA clinic, I could no longer prescribe to that same patient I’d been prescribing to while he or she was active duty.  The current VA restrictions are illogical….  Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico, and only through a third party contractor….  This just does not make sense and is a clear waste of federal funds.”  It makes me feel so good to know….   “It always seems impossible until it’s done.”  Aloha,

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

 

I SAW HER AGAIN LAST NIGHT….

 The Very Best of APA:  The annual APA Practice Directorate State Leadership Conference (SLC) continues to be the highlight of my APA year.  This spring 530 colleagues, including an impressive number of early career psychologists and first time attendees, were treated to another spectacular event.  New models of service delivery, the importance of integrated and patient-centered care; and focusing upon developing effective business plans, while simultaneously providing "value-add" were highlighted.  The Illinois Psychological Association's recent prescriptive authority success, thanks in large part to the dedication and persistence of Beth Rom-Rymer, brought new life to the RxP movement with a number of states reporting their membership being re-energized.  Ann Compton, former White House correspondent for ABC News presented a fascinating perspective on the inner workings of the Oval Office, when Hillary would finally announce, and the unique perspectives of the First Ladies.  This was also the 10^th anniversary of David Ballard's visionary Psychologically Healthy Workplace and Organizational Excellence Awards ceremony, which actively engages psychology with the best of the business community at both the local and national level.  Under Norman Anderson's leadership, APA itself was recently designated as one of the "Best Places to Work" by the Washington Post.  As always, the enthusiasm and excitement of the audience was palpable.

            The theme for this year's conference was Practice Innovation and Practice Directorate Executive Director Katherine Nordal challenged those present to step up and become visionary leaders.  "Innovation involves new ideas and processes, change, upheaval and transformation.  To be innovators we need to shake off some old ways of thinking about traditional practice models.  We also need to shake off the negative attitudes some of our colleagues have about what's happening in health care.  The world is changing and health care is moving ahead – with or without psychology.  Whether we move forward will be up to us!  We need to think differently about our professional roles and the way we provide services.  Too many psychologists are stuck in the traditional 50-minute therapy box.  And that box is way too confining.  We need to think creatively… how we practice… where we practice… and what we practice.

            "How can psychologists participate in the evolving system in ways that are good for us, our profession and our patients?  What effects will reforms in health care systems, financing and technology, have on us?  And, how do we, as leaders in our profession, support our members as these changes unfold?  We need to see and understand the bigger picture – the health care environment in which psychology lives.  Psychology should be the discipline that defines and expands the mental health quality measures available for Medicare and other public and private payers as these measures become more widely required.

"Clinical practice guidelines provide an example of our asserting a leadership role.  Historically, psychology has not been at the table.  That has enabled others to control the process, and payers have used their guidelines to determine what they will and will not pay for.  That will change as APA finalizes three initial guidelines – for PTSD, depression and obesity.  Guidelines developed by other disciplines often ignore the rich psychological science that informs good practice.  APA guidelines will identify the most effective psychological treatments for these disorders, regardless of the discipline providing the care.  Our guidelines development process is innovative.  APA's panels are multidisciplinary.  One of our cutting-edge, best practices is including community members on each panel to represent the patient perspective.

"You'll need a dose of courage to face the resistance you're going to encounter back home.  There will be times when your colleagues push back at your efforts at innovation.  Sometimes you'll hear your colleagues complain, 'We shouldn't change the way we've always done it.'  Or, 'That's not how I was trained.'  When you get that push back, what 3-word message are you going to give back to them?  'Shake it off.'  You are the leaders with the focused vision and vigilance needed to influence a challenging, changing health care system.  You are the leaders who will shape a vibrant future for professional psychology."

The Administration's Vision:  At a recent HRSA national Advisory meeting, the acting administrator discussed the Accountable Care Act's vision for improving access to quality care; fostering a more diverse workforce emphasizing team-based, interdisciplinary care; developing healthy communities (i.e., a population-based focus); and giving a priority to prevention ,while addressing historical health disparities.  This is Katherine's charge.

            A Very Special Personal Journey:  "The APA Congressional Science Fellowship program had a profound impact on my life and my career, and I am profoundly grateful for the experience.  At the most recent APA Council of Representatives meeting, former Congressman Brian Baird gave a talk at the plenary session and commented on the importance of the Fellowship for both the profession of psychology and for Congress itself.  You might recall that I was the first psychologist to be a Robert Wood Johnson (RWJ) Health Policy Fellow, and this predictably led to 'Potomac Fever.'  I loved working on the personal staff of Senator Tom Daschle, and cherish the time I spent with Tom (in both South Dakota and DC) and being mentored by Rima Cohen, his health policy legislative assistant.  Of course, the two-month Institute of Medicine (IOM) orientation helped too (e.g., our half-day lecture about and tour of HHS was given by then Secretary Lou Sullivan).  I wrote lots of speeches, drafted legislation, met with constituents, attended committee hearings, and was intimately involved with the reauthorization of funding for the National Health Service Corps.  Bob Frank was the second psychologist picked as an RWJ Fellow; I'm sure his time working for Senator Jeff Bingaman (D-NM) at least partially was responsible for his current position as President of the University of New Mexico.

"Realizing that I could never go back to running a neuropsychology lab, I resigned a tenured full professorship at the Marshall University School of Medicine, determined to reshape my life as a health policy maven.  I applied for both the APA Congressional Science Fellowship and the MPH program at Harvard.  I was accepted for both, but opted to stay in DC and continue to learn about the fascinating world of health policy.  Ted Kennedy, Jay Rockefeller and Pete Stark all offered me jobs on their personal staff, but Congressman John Conyers then chaired the House Government Operations Committee, and I accepted a position on his committee staff, in part because of my interest in promoting a Canadian style single payer health care system for the United States, something Congressman Conyers passionately supported.  In addition, after a year working in the Senate, I wanted to learn more about the House of Representatives.

            "While spending two years on the Hill, I had an opportunity to get actively involved with APA activities and operations (Fellows are invited to participate in almost all relevant APA conferences, meetings, events and summits).  This eventually led to my active participation in APA governance and presidency of three divisions (12, 46, and 52) as well as participation for several terms on the Council of Representatives.  During this second year working for the Congress, my former Dean at Marshall became the Dean of the School of Medicine at the University of Missouri.  Although a thoracic surgeon, this Dean was very psychologically minded, and he was determined to bring me back to the Academy.  He offered me an opportunity to direct the Missouri Institute of Mental Health (MIMH), a policy, research and training 'think tank' with over 100 employees and a budget of about $6 million.  MIMH operated at the interface of the University of Missouri and the Missouri Department of Mental Health, and our mission was to serve anyone in Missouri with a mental illness, addiction or developmental disability.  The job required lots of time in Jefferson City (the state capital) as well as tracking state legislative policy.  It was a job that wouldn't come around again, so I accepted the Dean's offer and happily spent the next 20 years running the Institute.  I never went back to being a neuropsychologist… but I never regretted making the shift from direct patient care to being a 'policy wonk.'

            "I simply couldn't have done the job at MIMH – and it would never have been offered – had I not spent time on the Hill as a congressional science and health policy fellow.  I like to think I made a real difference during the two decades I spent in Missouri, and I've had opportunities to introduce literally thousands of students to health policy issues, both in Missouri and while serving as an Associate Dean at the California School of Professional Psychology (CSPP).  I also make sure the medical students I'm now teaching at the American University of Antigua know something about how health policy is shaped and how profoundly their professional lives will be affected by what happens in the halls of Congress and in state legislatures.  (A fortuitous and entirely unexpected benefit of being a former APA/AAAS Fellow was being invited to Canberra to testify before a subcommittee of the Australian Parliament about my experiences working on the Hill.)  Our 40^th Congressional Science Fellowship anniversary celebration at our last convention was truly memorable" [Danny Wedding].

            Change Is Inescapable; Although It Does Take Time:  As Katherine so apply notes, a number of our colleagues appear to be intractably resistant to change.  Apparently, however, this fundamental orientation is not limited to the discipline of psychology.  In reading about Rear Admiral Grace Hopper, who was a pioneering computer specialist, and who retired in 1986 as the Navy's oldest serving officer (having served for 42 years), I smiled learning: "In general, applied mathematicians were looked down on by their colleagues in pure mathematics.  There was a widespread belief that 'you turned to applied mathematics if you found the going too hard in pure mathematics.'"  Thank goodness for colleagues like former Division and APA President Ron Fox who continues to press for change, now meeting almost monthly with APA's Heather Kelly strategizing about how to get psychologists -- who are themselves veterans -- to insist that they should continue to have access to the services of prescribing psychologists within the VA, as they did while on active duty.

Former USAF Prescribing Psychologist Elaine Foster recently wrote her own elected official: "After graduating from the DoD Psychopharmacology Demonstration Project (PDP) I served as a prescribing psychologist in the Air Force for over 20 years.  I continued to serve our active duty military after retiring, again as a prescribing psychologist under contract with the Air Force.  During that time, I prescribed for our veterans when we had space available at our military clinic….  If I walked across the hospital parking lot to our annexed VA clinic, I could no longer prescribe to that same patient I'd been prescribing to while he or she was active duty.  The current VA restrictions are illogical….  Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico, and only through a third party contractor….  This just does not make sense and is a clear waste of federal funds."  It makes me feel so good to know….   "It always seems impossible until it's done."  Aloha,

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

 

THE INEVITABLE WINDS OF CHANGE

 From a public policy/political perspective, one can sense that the U.S. Congress is steadily returning to the days of bipartisanship, collaboration, and focusing upon meaningful accomplishments.  Recently, a number of congressional committees have recommended bipartisan bills; the most directly relevant to psychology is the Medicare "Doc Fix" legislation which has been a high priority for APA over the past several years, notwithstanding that it will add $141 billion to the projected federal deficit over the next decade.  The potentially highly emotionally charged "No Child Left Behind" reauthorization was unanimously endorsed by the Senate HELP Committee, while efforts to reform civil-asset forfeiture laws have gained strong bipartisan support within the Senate Judiciary Committee.  Although initially tied to the Attorney General's confirmation deliberations, the far reaching Sex-Trafficking legislation was ultimately sent to the President after a 99-0 Senate vote.  Similarly, this spring the Senate Commerce Committee has been exploring telehealth issues, again on a bipartisan basis.  These efforts would simply not happen without the strong encouragement of the leadership of both political parties.

            The APA State Leadership Conference (SLC):  The theme for this year's exciting APA State Leadership Conference (SLC) was Practice Innovationand it was the 10^th anniversary of David Ballard's visionary Psychologically Healthy Workplace and Organizational Excellence awards presentations.  Katherine Nordal stressed that: "Innovation involves new ideas and processes, change, upheaval and transformation.  To be innovators we need to shake off some old ways of thinking about traditional practice models.  We also need to shake off the negative attitudes some of our colleagues have about what's happening in health care.  This world is changing.  Everyone in this room knows it.  And health care is moving ahead – with or without psychology.  Whether we move forward will be up to us!  We need to think differently about our professional roles and the way we provide services.  Too many psychologists are stuck in the traditional 50-minute therapy box.  And that box is way too confining.  We need to think creatively about where psychology can best influence our evolving health care system… how we practice… where we practice… and what we practice."

            Katherine recently addressed our interdisciplinary health policy class at USUHS and, as she did at SLC, urged our next generation to see and understand the bigger picture – the health care environment in which psychology (and nursing) lives.  "We've developed a new registry to help fix the problem of low success rates with claims-based reporting, and to protect psychologists' Medicare payments.  Our Practice Organization was the first and only mental health organization to develop a registry.  Unlike other registries, our APAPO RQRSPRO focuses on mental and behavioral health measures.  We rolled out the registry in December and already have almost 1,200 registrants.  We have long-term aspirations.  We're laying the groundwork for a qualified clinical data registry.  Such a registry would give psychologists more choices of quality measures that better reflect the work that we do.  Psychology should be the discipline that defines and expands the mental health quality measures available for Medicare and other public and private payers as these measures become more widely required."

            I was particularly pleased to see her continuing emphasis upon engaging psychology with Medicaid, which is one of the foundations of President Obama's Patient Protection and Affordable Care Act (ACA).  The Congressional Budget Office (CBO) estimates that the ACA will reduce the number of uninsured Americans by 32 million.  Medicaid, which is a state administered program, is the largest single payer for mental health services in the nation, and as Katherine pointed out with Arkansas's recent success, has the potential for reimbursing the services of psychology's interns.  Getting psychologists to seek recognition under Medicaid has been a struggle given its traditional lower reimbursement rates; however, those with vision could appreciate its long term significance even prior to the enactment of the ACA.

            Most fittingly, Katherine also expressed all of psychology's appreciation for the successful efforts of the Illinois Psychological Association and Beth Rom-Rymer in particular.  "I want to share an example of a state that did a great job with collaborating and building partnerships.  That state is Illinois, gaining prescriptive authority for qualified psychologists.  And yes, it happened in the state that's home to the American Medical Association!  Hats off to Dr. Beth Rom-Rymer, who led the charge with her colleagues in Illinois.  It was a big win – the culmination of several years of tireless advocacy and a hard-fought legislative battle.  Our Illinois leaders demonstrated amazing skill in laying the groundwork for bringing medicine to the negotiating table and gaining support from a variety of organizations and groups – stakeholders like federally qualified health centers, prisons and the sheriff's association.  This win in Illinois has reinvigorated our profession's quest for prescriptive authority.  Idaho, Hawaii, New Jersey, North Dakota and Nebraska are engaged in legislative activity this year, and they're getting results."

            Integrating Behavioral Health Into Primary Care:  The California Technology Assessment Forum (CTAF) recently addressed the comparative clinical effectiveness and value of integrated behavioral health care.  "Despite a long history of treating physical health conditions separately from behavioral health, the two are inextricably linked.  Up to 70% of physician visits are for issues with a behavioral health component.  A similar proportion of adults with behavioral health conditions have one or more physical health issues….  Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions."

            As Katherine consistently emphasizes, CTAF also noted that no single approach to integration will work for all communities; rather, integration should be designed for a particular set of local or statewide circumstances.  "In sum, there is a very large body of literature on the integration of mental health into primary care.  Studies of different models of integration across wildly varying delivery systems demonstrate with great consistency that integrated care improves depression and anxiety outcomes, although the absolute benefits are only small to modest.  Furthermore, integrated care improves patient quality of life and satisfaction with care."

            A Personal Reflection:  A number of years ago, former APA President Stan Graham shared his thoughts about the prospect of having to decide what to do with all of the awards and plaques he had received over the decades.  Perhaps send some of them to David Baker at the University of Akron's Psychology Achieves for posterity?  When they visit, our two grandchildren love to play in our closed-off roof dormer room.  The competition for that limited space is exactly what Stan described.  What to do with the Honorary Degree that former APA President Ron Levant bestowed upon me at Nova Southeastern University, or the impressive APA plaques and those from the State Associations which I visited during the past four decades?  How about the autographed photographs with our psychology colleagues who have been elected to the U.S. House of Representatives or the meeting we arranged with then First Lady Hillary Clinton to provide APA with the opportunity to talk about her National Health Insurance proposal?  Fond memories.  However....  The Inevitable Winds Of Change.  Aloha,

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

 

Division 42 May, 2015 column

THE INEVITABLE WINDS OF CHANGE

            From a public policy/political perspective, one can sense that the U.S. Congress is steadily returning to the days of bipartisanship, collaboration, and focusing upon meaningful accomplishments.  Recently, a number of congressional committees have recommended bipartisan bills; the most directly relevant to psychology is the Medicare “Doc Fix” legislation which has been a high priority for APA over the past several years, notwithstanding that it will add $141 billion to the projected federal deficit over the next decade.  The potentially highly emotionally charged “No Child Left Behind” reauthorization was unanimously endorsed by the Senate HELP Committee, while efforts to reform civil-asset forfeiture laws have gained strong bipartisan support within the Senate Judiciary Committee.  Although initially tied to the Attorney General’s confirmation deliberations, the far reaching Sex-Trafficking legislation was ultimately sent to the President after a 99-0 Senate vote.  Similarly, this spring the Senate Commerce Committee has been exploring telehealth issues, again on a bipartisan basis.  These efforts would simply not happen without the strong encouragement of the leadership of both political parties.

            The APA State Leadership Conference (SLC):  The theme for this year’s exciting APA State Leadership Conference (SLC) was Practice Innovation and it was the 10^th anniversary of David Ballard’s visionary Psychologically Healthy Workplace and Organizational Excellence awards presentations.  Katherine Nordal stressed that: “Innovation involves new ideas and processes, change, upheaval and transformation.  To be innovators we need to shake off some old ways of thinking about traditional practice models.  We also need to shake off the negative attitudes some of our colleagues have about what’s happening in health care.  This world is changing.  Everyone in this room knows it.  And health care is moving ahead – with or without psychology.  Whether we move forward will be up to us!  We need to think differently about our professional roles and the way we provide services.  Too many psychologists are stuck in the traditional 50-minute therapy box.  And that box is way too confining.  We need to think creatively about where psychology can best influence our evolving health care system… how we practice… where we practice… and what we practice.”

            Katherine recently addressed our interdisciplinary health policy class at USUHS and, as she did at SLC, urged our next generation to see and understand the bigger picture – the health care environment in which psychology (and nursing) lives.  “We’ve developed a new registry to help fix the problem of low success rates with claims-based reporting, and to protect psychologists’ Medicare payments.  Our Practice Organization was the first and only mental health organization to develop a registry.  Unlike other registries, our APAPO RQRSPRO focuses on mental and behavioral health measures.  We rolled out the registry in December and already have almost 1,200 registrants.  We have long-term aspirations.  We’re laying the groundwork for a qualified clinical data registry.  Such a registry would give psychologists more choices of quality measures that better reflect the work that we do.  Psychology should be the discipline that defines and expands the mental health quality measures available for Medicare and other public and private payers as these measures become more widely required.”

            I was particularly pleased to see her continuing emphasis upon engaging psychology with Medicaid, which is one of the foundations of President Obama’s Patient Protection and Affordable Care Act (ACA).  The Congressional Budget Office (CBO) estimates that the ACA will reduce the number of uninsured Americans by 32 million.  Medicaid, which is a state administered program, is the largest single payer for mental health services in the nation, and as Katherine pointed out with Arkansas’s recent success, has the potential for reimbursing the services of psychology’s interns.  Getting psychologists to seek recognition under Medicaid has been a struggle given its traditional lower reimbursement rates; however, those with vision could appreciate its long term significance even prior to the enactment of the ACA.

            Most fittingly, Katherine also expressed all of psychology’s appreciation for the successful efforts of the Illinois Psychological Association and Beth Rom-Rymer in particular.  “I want to share an example of a state that did a great job with collaborating and building partnerships.  That state is Illinois, gaining prescriptive authority for qualified psychologists.  And yes, it happened in the state that’s home to the American Medical Association!  Hats off to Dr. Beth Rom-Rymer, who led the charge with her colleagues in Illinois.  It was a big win – the culmination of several years of tireless advocacy and a hard-fought legislative battle.  Our Illinois leaders demonstrated amazing skill in laying the groundwork for bringing medicine to the negotiating table and gaining support from a variety of organizations and groups – stakeholders like federally qualified health centers, prisons and the sheriff’s association.  This win in Illinois has reinvigorated our profession’s quest for prescriptive authority.  Idaho, Hawaii, New Jersey, North Dakota and Nebraska are engaged in legislative activity this year, and they’re getting results.”

            Integrating Behavioral Health Into Primary Care:  The California Technology Assessment Forum (CTAF) recently addressed the comparative clinical effectiveness and value of integrated behavioral health care.  “Despite a long history of treating physical health conditions separately from behavioral health, the two are inextricably linked.  Up to 70% of physician visits are for issues with a behavioral health component.  A similar proportion of adults with behavioral health conditions have one or more physical health issues….  Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions.”

            As Katherine consistently emphasizes, CTAF also noted that no single approach to integration will work for all communities; rather, integration should be designed for a particular set of local or statewide circumstances.  “In sum, there is a very large body of literature on the integration of mental health into primary care.  Studies of different models of integration across wildly varying delivery systems demonstrate with great consistency that integrated care improves depression and anxiety outcomes, although the absolute benefits are only small to modest.  Furthermore, integrated care improves patient quality of life and satisfaction with care.”

            A Personal Reflection:  A number of years ago, former APA President Stan Graham shared his thoughts about the prospect of having to decide what to do with all of the awards and plaques he had received over the decades.  Perhaps send some of them to David Baker at the University of Akron’s Psychology Achieves for posterity?  When they visit, our two grandchildren love to play in our closed-off roof dormer room.  The competition for that limited space is exactly what Stan described.  What to do with the Honorary Degree that former APA President Ron Levant bestowed upon me at Nova Southeastern University, or the impressive APA plaques and those from the State Associations which I visited during the past four decades?  How about the autographed photographs with our psychology colleagues who have been elected to the U.S. House of Representatives or the meeting we arranged with then First Lady Hillary Clinton to provide APA with the opportunity to talk about her National Health Insurance proposal?  Fond memories.  However....  The Inevitable Winds Of Change.  Aloha,

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