HPA June, 2015 column

“WE MUST SEEK AN EDUCATIONAL SYSTEM WHICH GROWS IN EXCELLENCE”

            Interdisciplinary Care:  From a health policy perspective, one of the most significant changes occurring within our nation’s healthcare system is the increasing emphasis upon interdisciplinary or interprofessional team-based care.  Within the framework of the President’s Patient Protection and Affordable Care Act (ACA) this is perhaps most evident within the envisioned Accountable Care Organization (ACO) and Patient-Centered Medical Home provisions of the law.  Reimbursement models must change but as Katherine Nordal proclaimed at this spring’s exciting State Leadership Conference (SLC): “We need to shake off the negative attitudes some of our colleagues have about what’s happening in health care.  This world is changing.  And health care is moving ahead – with or without psychology.”

A recent Institute of Medicine (IOM) report noted: “Much has changed over the past decade, necessitating new thinking.  Innovators at that time stressed the importance of ‘patient-centered care,’ while today they think of patients as partners in health promotion and health care delivery.  Patients are integral members of the care team, not solely patients to be treated, and the team is recognized as comprising a variety of health professionals.  This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models.”

            “One of the most exciting developments along this line at the Uniformed Services University of the Health Sciences (USUHS) (DoD) has been the recent collaborative effort by the leadership of the clinical psychology program and the Doctor of Nursing Practice Psychiatric Mental Health Nurse Practitioner program to jointly utilize the university’s simulation laboratory with its professional actors.  This team-based approach of treating ‘patients (actors)’ in the educational setting provides improved learning across all spectrums.  The faculty and students from both disciplines report improved knowledge and feedback following the ‘patient’ encounters.  Additionally, the collaborative effort models better utilization of resources since both programs are utilizing the actors simultaneously.  These sessions have generated a considerable amount of interprofessional dialogue and better understanding of the respective roles and responsibilities of each profession.  Future plans are being made for the programs to continue these training sessions in the upcoming therapeutic modalities course and psychopharmacology courses.  Ultimately, this team-effort is helping to better prepare the students to safely and efficiently care for actual patients in today’s health care delivery system” (Eric Pauli, Graduate School of Nursing faculty).

            “At USUHS doctoral students in nursing and psychology can partake in a Friday afternoon public policy seminar with various guest speakers.  Speakers have included high level APA staff, former and current military leaders, two former Secretaries of the Department of Veterans Affairs, executive staff from pharmacy and nursing professional organizations, and various health policy influencers such as the Institute of Medicine (IOM).  These speakers share stories that convey the true art of policy making with a focus on building positive and lasting relationships across all health disciplines and in local, state, and federal government.  Students regularly remark on common themes across speakers and frequently visit the class beyond their formal semester.  Further, students in nursing and psychology build lasting professional relationships based on class discussions and off-site field visits to places such as the World Bank, APA, and Congressional offices” (Joanna Sells, psychology Ph.D. student).

            Exciting Opportunities for Those with Vision:  At the most recent meeting of the HRSA Advisory Committee on Interdisciplinary, Community-Based Linkages, we reviewed the HHS December, 2010 report Multiple Chronic Conditions: A Strategic Framework, which expressly mentions psychology and nursing.  This strategic framework to improve the health status of individuals with multiple chronic conditions emphasizes the importance of preventing their occurrence.  An enhanced focus on prevention and public health is seen as essential to ensuring optimum health and quality of life.  The report seeks to catalyze change within the context of how chronic illnesses are addressed – from a focus on individual chronic diseases to one that uses a multiple chronic conditions approach.  This cultural change, or paradigm shift, and the subsequent implementation of these strategies will provide the foundation for realizing the vision of optimum health and quality of life for individuals with multiple chronic conditions.

            More than one in four Americans have multiple (two or more) concurrent chronic conditions (MCC); for example, arthritis, asthma, chronic respiratory conditions, diabetes, heart disease, HIV, and hypertension.  In addition, these include substance use and addition disorders, mental illnesses, cognitive impairment disorders, and developmental disabilities.  The prevalence of MCC among individuals increases with age and is substantial among older adults, even though many are under the age of 65.  As the number of chronic conditions in an individual increases, the risks of mortality, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice increases.  The resource implications for addressing MCC are immense – 66% of total health care spending is directed toward care for the approximately 27% of Americans with MCC.  “The poor health outcomes of individuals with serious mental illnesses and other behavioral health problems warrants special attention because of the co-occurrences of those conditions with other chronic conditions.”  More than 50 efforts across HHS were found which are directed primarily to the health care needs of individuals with two or more chronic health conditions.

            Health care, public health, and social services professionals and family caregivers practice in a vacuum of published data regarding care for those with multiple chronic conditions.  As the IOM report noted, health care, public health, and social services professionals are dependent on and influenced by training programs that prepare them for the environments in which they will practice.  Evidence suggests that many health care professional trainees feel uncomfortable with key chronic care competencies.  Addressing these gaps, as well as the need for improving providers’ cultural competencies, will ensure that the current and next generations of providers are proficient in caring for individuals with MCC and in interacting with family caregivers.  Specifically, HHS recommended developing and fostering training within both traditional and nontraditional professional settings (e.g., medicine, nursing, social work, psychology/counseling, clinical pharmacy, chaplaincy, vocational rehabilitation, community health workers) that emphasizes increased competency in palliative and patient-centered approaches.  As psychology expands its training modules to include federally qualified community health centers (FCHCs) and the evolving ACA accountable care organizations and patient-centered medical homes (both of which might well become extensions of larger hospitals and HMOs) the clinical opportunities to work with patients with MCC and thereby demonstrate “value-add” will significantly increase.  As Katherine Nordal noted at SLC: “This world is changing.  And health care is moving ahead – with or without psychology.”  “It means exploring new techniques… to find new ways to stimulate the love of learning and the capacity for creation.”  Aloha,

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

 

“WE MUST SEEK AN EDUCATIONAL SYSTEM WHICH GROWS IN EXCELLENCE”

  Interdisciplinary Care:  From a health policy perspective, one of the most significant changes occurring within our nation's healthcare system is the increasing emphasis upon interdisciplinary or interprofessional team-based care.  Within the framework of the President's Patient Protection and Affordable Care Act (ACA) this is perhaps most evident within the envisioned Accountable Care Organization (ACO) and Patient-Centered Medical Home provisions of the law.  Reimbursement models must change but as Katherine Nordal proclaimed at this spring's exciting State Leadership Conference (SLC): "We need to shake off the negative attitudes some of our colleagues have about what's happening in health care.  This world is changing.  And health care is moving ahead – with or without psychology."

A recent Institute of Medicine (IOM) report noted: "Much has changed over the past decade, necessitating new thinking.  Innovators at that time stressed the importance of 'patient-centered care,' while today they think of patients as partners in health promotion and health care delivery.  Patients are integral members of the care team, not solely patients to be treated, and the team is recognized as comprising a variety of health professionals.  This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models."

            "One of the most exciting developments along this line at the Uniformed Services University of the Health Sciences (USUHS) (DoD) has been the recent collaborative effort by the leadership of the clinical psychology program and the Doctor of Nursing Practice Psychiatric Mental Health Nurse Practitioner program to jointly utilize the university's simulation laboratory with its professional actors.  This team-based approach of treating 'patients (actors)' in the educational setting provides improved learning across all spectrums.  The faculty and students from both disciplines report improved knowledge and feedback following the 'patient' encounters.  Additionally, the collaborative effort models better utilization of resources since both programs are utilizing the actors simultaneously.  These sessions have generated a considerable amount of interprofessional dialogue and better understanding of the respective roles and responsibilities of each profession.  Future plans are being made for the programs to continue these training sessions in the upcoming therapeutic modalities course and psychopharmacology courses.  Ultimately, this team-effort is helping to better prepare the students to safely and efficiently care for actual patients in today's health care delivery system" (Eric Pauli, Graduate School of Nursing faculty).

            "At USUHS doctoral students in nursing and psychology can partake in a Friday afternoon public policy seminar with various guest speakers.  Speakers have included high level APA staff, former and current military leaders, two former Secretaries of the Department of Veterans Affairs, executive staff from pharmacy and nursing professional organizations, and various health policy influencers such as the Institute of Medicine (IOM).  These speakers share stories that convey the true art of policy making with a focus on building positive and lasting relationships across all health disciplines and in local, state, and federal government.  Students regularly remark on common themes across speakers and frequently visit the class beyond their formal semester.  Further, students in nursing and psychology build lasting professional relationships based on class discussions and off-site field visits to places such as the World Bank, APA, and Congressional offices" (Joanna Sells, psychology Ph.D. student).

            Exciting Opportunities for Those with Vision:  At the most recent meeting of the HRSA Advisory Committee on Interdisciplinary, Community-Based Linkages, we reviewed the HHS December, 2010 report Multiple Chronic Conditions: A Strategic Framework, which expressly mentions psychology and nursing.  This strategic framework to improve the health status of individuals with multiple chronic conditions emphasizes the importance of preventing their occurrence.  An enhanced focus on prevention and public health is seen as essential to ensuring optimum health and quality of life.  The report seeks to catalyze change within the context of how chronic illnesses are addressed – from a focus on individual chronic diseases to one that uses a multiple chronic conditions approach.  This cultural change, or paradigm shift, and the subsequent implementation of these strategies will provide the foundation for realizing the vision of optimum health and quality of life for individuals with multiple chronic conditions.

            More than one in four Americans have multiple (two or more) concurrent chronic conditions (MCC); for example, arthritis, asthma, chronic respiratory conditions, diabetes, heart disease, HIV, and hypertension.  In addition, these include substance use and addition disorders, mental illnesses, cognitive impairment disorders, and developmental disabilities.  The prevalence of MCC among individuals increases with age and is substantial among older adults, even though many are under the age of 65.  As the number of chronic conditions in an individual increases, the risks of mortality, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice increases.  The resource implications for addressing MCC are immense – 66% of total health care spending is directed toward care for the approximately 27% of Americans with MCC.  "The poor health outcomes of individuals with serious mental illnesses and other behavioral health problems warrants special attention because of the co-occurrences of those conditions with other chronic conditions."  More than 50 efforts across HHS were found which are directed primarily to the health care needs of individuals with two or more chronic health conditions.

            Health care, public health, and social services professionals and family caregivers practice in a vacuum of published data regarding care for those with multiple chronic conditions.  As the IOM report noted, health care, public health, and social services professionals are dependent on and influenced by training programs that prepare them for the environments in which they will practice.  Evidence suggests that many health care professional trainees feel uncomfortable with key chronic care competencies.  Addressing these gaps, as well as the need for improving providers' cultural competencies, will ensure that the current and next generations of providers are proficient in caring for individuals with MCC and in interacting with family caregivers.  Specifically, HHS recommended developing and fostering training within both traditional and nontraditional professional settings (e.g., medicine, nursing, social work, psychology/counseling, clinical pharmacy, chaplaincy, vocational rehabilitation, community health workers) that emphasizes increased competency in palliative and patient-centered approaches.  As psychology expands its training modules to include federally qualified community health centers (FCHCs) and the evolving ACA accountable care organizations and patient-centered medical homes (both of which might well become extensions of larger hospitals and HMOs) the clinical opportunities to work with patients with MCC and thereby demonstrate "value-add" will significantly increase.  As Katherine Nordal noted at SLC: "This world is changing.  And health care is moving ahead – with or without psychology."  "It means exploring new techniques… to find new ways to stimulate the love of learning and the capacity for creation."  Aloha,

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

 

Illinois Psychological Association June, 2015 column

THE RING OF FIRE

            The Illinois Psychological Association’s success in enacting prescriptive authority (RxP) legislation into public law, signed by Governor Pat Quinn on June 25, 2014, is most impressive; especially in the home state of the American Medical Association.  It is wonderful for your patients, for the profession, and for the nation.  And it only could have happened with the strong, cohesive state association that you are.  This landmark legislative success, that empowers psychologists to provide comprehensive, integrative health care for the underserved, reflects the unprecedented changes occurring within our nation’s health care system, epitomized by the enactment of President Obama’s Patient Protection and Affordable Care Act (ACA).  As Practice Directorate Executive Director Kathleen Nordal proclaimed during this year’s inspirational APA State Leadership Conference (SLC), where the Illinois Psychological Association was honored: “We need to shake off the negative attitudes some of our colleagues have about what’s happening in health care.  This world is changing.  And health care is moving ahead – with or without psychology.  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.”

            As hard as it is to believe, it had been a decade since Jim Quillin and his colleagues succeeded in Louisiana.  During that time, Hawaii and Oregon had bills passed by their legislatures only to be vetoed.  Neither state association pursued follow up legislation until this legislative cycle when Hawaii was again successful in having its bill pass the House of Representatives.  A January, 2005 fact sheet/memorandum from the Department of Veterans Affairs (VA), regarding optometry’s efforts to expand its scope of practice, serves as a vivid reminder that the opposition to psychology’s prescriptive authority quest is neither about patient care nor about the lack of objective supporting data.  Former APA President Ron Fox has made that clear.  “As of December 31, 2013 when I was Chair of the APA Insurance Trust, I can attest to the fact that because the Trust policy provides insurance to cover expenses related to licensing board complaints, I know that there have been no complaints or actions taken by state licensing boards regarding prescribing abuses by appropriate trained psychologists.”  Jana Martin, CEO of The Trust, reports that there has been only a 15% increase in liability rates ( $75 - $150 annually) for psychologists who are licensed to prescribe.

The VA fact sheet on Laser Eye Procedures Performed by Optometrists noted: “The Veterans Health Administration (VHA) reviewed the 35 cases of laser therapy performed by optometrists, and also reviewed the previous assessments of the care these veterans received.  A practicing ophthalmologist was asked to review these cases as well.  Of the 35 cases, 32 patients underwent an Yttrium Aluminum Garnet (YAG) posterior capsulotomy for capsular opacification following cataract removal.  The remaining three had bilateral peripheral iridotomies for angle crowding.  The overall outcomes of these patients were acceptable and there were no significant complications.  Based on this review and analysis of previous assessments, VHA concludes that the outcomes of these patients were acceptable.”  Not surprisingly, organized medicine nevertheless opined to the Congress that optometrists performing this clinical procedure represented a “public health hazard” and were subjecting veterans to less than optimal care.

In many ways, the ongoing battles between optometry and their medical counterparts parallels what psychology faces, as do the disagreements between advanced practice nursing and medicine.  The  Department of Defense (DoD) Walter Reed/Uniformed Services University of the Health Sciences psychopharmacology training program (frequently referred to as the PDP) began in the summer of 1991, and was closely monitored by the American College of Neuropsychopharmacology (ACNP).  ACNP’s conclusion: “All 10 graduates of the PDP filled critical needs, and they performed with excellence wherever they were placed.”  On June 17, 1994, Navy Commander John Sexton and Lt. Commander Morgan Sammons became the first graduates and as Ron Fox has noted, DoD prescribing psychologists provide excellent care.  And yet, why haven’t the VA and our private health care systems enthusiastically embraced this potential for psychology providing quality care?  We would suggest the missing element has been psychology’s hesitation in accepting this important clinical responsibility.  Very few of our colleagues appreciate their societal responsibility to be visionary leaders in addressing society’s real needs, as Beth Rom-Rymer and your other colleagues in Illinois have.

Former USAF Prescribing Psychologist Elaine Foster recently shared her concerns with 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.”

Bob McGrath, Director of the clinical psychopharmacology training program at Fairleigh Dickinson University, estimates that today there are more than 1,750 psychologists who have completed their post-doctoral psychopharmacology training.  When the APA Council of Representatives endorsed RxP as association policy in 1995, that standard was reasonably adopted in order to address the sincere concerns of those who were afraid that psychology might lose its fundamental identity.  However, as Katherine points out, times have changed and it is now appropriate that you, Illinois psychologists, are facilitating psychopharmacology training at the graduate level, as well as facilitating training in the basic sciences at the undergraduate level, throughout your state.  Those students who are passionate about the study of psychology and are strong in the hard sciences will be well prepared for a career as a prescribing psychologist.  The Illinois Psychological Association has demonstrated to all of us that psychology can be in control of its own destiny and is willing to change with the times.  My sincerest appreciation for your vision, persistence, and responsiveness to your patients’ real needs.  And, it burns, burns, burns.  Aloha,

Pat DeLeon, former APA President – Illinois Psychological Association – June, 2015

 

 

THE RING OF FIRE

The Illinois Psychological Association's success in enacting prescriptive authority (RxP) legislation into public law, signed by Governor Pat Quinn on June 25, 2014, is most impressive; especially in the home state of the American Medical Association.  It is wonderful for your patients, for the profession, and for the nation.  And it only could have happened with the strong, cohesive state association that you are.  This landmark legislative success, that empowers psychologists to provide comprehensive, integrative health care for the underserved, reflects the unprecedented changes occurring within our nation's health care system, epitomized by the enactment of President Obama's Patient Protection and Affordable Care Act (ACA).  As Practice Directorate Executive Director Kathleen Nordal proclaimed during this year's inspirational APA State Leadership Conference (SLC), where the Illinois Psychological Association was honored: "We need to shake off the negative attitudes some of our colleagues have about what's happening in health care.  This world is changing.  And health care is moving ahead – with or without psychology.  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."

            As hard as it is to believe, it had been a decade since Jim Quillin and his colleagues succeeded in Louisiana.  During that time, Hawaii and Oregon had bills passed by their legislatures only to be vetoed.  Neither state association pursued follow up legislation until this legislative cycle when Hawaii was again successful in having its bill pass the House of Representatives.  A January, 2005 fact sheet/memorandum from the Department of Veterans Affairs (VA), regarding optometry's efforts to expand its scope of practice, serves as a vivid reminder that the opposition to psychology's prescriptive authority quest is neither about patient care nor about the lack of objective supporting data.  Former APA President Ron Fox has made that clear.  "As of December 31, 2013 when I was Chair of the APA Insurance Trust, I can attest to the fact that because the Trust policy provides insurance to cover expenses related to licensing board complaints, I know that there have been no complaints or actions taken by state licensing boards regarding prescribing abuses by appropriate trained psychologists."  Jana Martin, CEO of The Trust, reports that there has been only a 15% increase in liability rates ( $75 - $150 annually) for psychologists who are licensed to prescribe. 

The VA fact sheet on Laser Eye Procedures Performed by Optometrists noted: "The Veterans Health Administration (VHA) reviewed the 35 cases of laser therapy performed by optometrists, and also reviewed the previous assessments of the care these veterans received.  A practicing ophthalmologist was asked to review these cases as well.  Of the 35 cases, 32 patients underwent an Yttrium Aluminum Garnet (YAG) posterior capsulotomy for capsular opacification following cataract removal.  The remaining three had bilateral peripheral iridotomies for angle crowding.  The overall outcomes of these patients were acceptable and there were no significant complications.  Based on this review and analysis of previous assessments, VHA concludes that the outcomes of these patients were acceptable."  Not surprisingly, organized medicine nevertheless opined to the Congress that optometrists performing this clinical procedure represented a "public health hazard" and were subjecting veterans to less than optimal care.

In many ways, the ongoing battles between optometry and their medical counterparts parallels what psychology faces, as do the disagreements between advanced practice nursing and medicine.  The  Department of Defense (DoD) Walter Reed/Uniformed Services University of the Health Sciences psychopharmacology training program (frequently referred to as the PDP) began in the summer of 1991, and was closely monitored by the American College of Neuropsychopharmacology (ACNP).  ACNP's conclusion: "All 10 graduates of the PDP filled critical needs, and they performed with excellence wherever they were placed."  On June 17, 1994, Navy Commander John Sexton and Lt. Commander Morgan Sammons became the first graduates and as Ron Fox has noted, DoD prescribing psychologists provide excellent care.  And yet, why haven't the VA and our private health care systems enthusiastically embraced this potential for psychology providing quality care?  We would suggest the missing element has been psychology's hesitation in accepting this important clinical responsibility.  Very few of our colleagues appreciate their societal responsibility to be visionary leaders in addressing society's real needs, as Beth Rom-Rymer and your other colleagues in Illinois have.

Former USAF Prescribing Psychologist Elaine Foster recently shared her concerns with 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."

Bob McGrath, Director of the clinical psychopharmacology training program at Fairleigh Dickinson University, estimates that today there are more than 1,750 psychologists who have completed their post-doctoral psychopharmacology training.  When the APA Council of Representatives endorsed RxP as association policy in 1995, that standard was reasonably adopted in order to address the sincere concerns of those who were afraid that psychology might lose its fundamental identity.  However, as Katherine points out, times have changed and it is now appropriate that you, Illinois psychologists, are facilitating psychopharmacology training at the graduate level, as well as facilitating training in the basic sciences at the undergraduate level, throughout your state.  Those students who are passionate about the study of psychology and are strong in the hard sciences will be well prepared for a career as a prescribing psychologist.  The Illinois Psychological Association has demonstrated to all of us that psychology can be in control of its own destiny and is willing to change with the times.  My sincerest appreciation for your vision, persistence, and responsiveness to your patients' real needs.  And, it burns, burns, burns.  Aloha,

Pat DeLeon, former APA President – Illinois Psychological Association – June, 2015

 

ALOHA - Division 18 column, June 2015

SLOW DOWN, YOU MOVE TOO FAST

            Give An Hour:  This spring we had the unique opportunity to attend Give an Hour’s national conference highlighting their “Campaign to Change Direction” in the way that the nation talks about mental health.  First Lady Michelle Obama was the inspirational keynote speaker.  Other speakers included psychologists Barbara Van Dahlen, Founder and President of Give an Hour; Norman Anderson, Art Evans, and Randy Phelps.  Most memorable were the testimonials from veterans who had personally experienced the anxiety, depression, and suicidal ideation of PSTD.  Over 50 organizations were engaged that morning; the number now being in excess of 100.

Barbara: “Give an Hour’s work these last 10 years has taught us a very important lesson.  The greatest barrier to ensuring proper mental health support for those who serve and their families is not a shortage of appropriately trained mental health professionals or the lack of effective treatments for specific conditions and concerns.  The greatest barrier to effectively addressing the mental health needs of those who serve is the same barrier that prevents civilians with mental health concerns from receiving proper care.  It is the same barrier that leads to 39,000 suicides each year in America, including the deaths of 22 veterans each day.  The greatest barrier to ensuring the mental health well-being of all of our citizens, civilians and military, is our culture itself.  The manner in which we view and respond to mental health prevents service members and their families, just as it prevents civilians, from recognizing and acknowledging the suffering that we see in ourselves and others.  Until we change our culture so that mental health is viewed in the same way we view physical health – as one of many important elements of being human – we will continue to fail those in need.”  Mrs. Obama rhetorically asked: “Should not mental health be viewed in the same manner as cancer, diabetes, and other physical ailments?”  Barry Anton points out in his May Monitor Presidential column that 70 percent of primary-care visits stem from psychosocial factors.

“At the core of the campaign – and the cultural movement it is inspiring – is a plan to educate all Americans on the five signs of emotional suffering.  Just as we recognize the signs that someone may be having a heart attack, we can learn the signs that may indicate that someone we know is in emotional pain and needs our help.  And if we recognize these signs in others, we reach out, we connect, we offer to help.  By creating a common language and the recognition that we can all pay attention to our mental well-being, we have the opportunity to reduce suffering and build healthy communities (Barbara).”  Visit www.changedirection.org.  A truly impressive vision, one which highlights the importance of psychology becoming integrated into primary care, for both the profession and our clients.

            Another Exciting Vision:  The former chief academic affiliations officer for the Department of Veterans Affairs (VA), Malcolm Cox, chaired the recent IOM report Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes.  His report notes that much has changed over the past decade, necessitating new thinking.  Innovators then stressed the importance of patient-centered care; today, they think of patients as partners in health promotion and health care delivery.  Patients are now to be integral members of the care team, not solely patients to be treated; and the team is recognized as comprising a variety of health professionals.  This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models.

            The VA has a very impressive record of integrating education and clinical care.  Under Robert Zeiss’s leadership (2005-2013), and continuing today under Kenneth Jones, psychology’s post-doctoral training thrived with the annual number of funded positions increasing from 52 to 402, and with a significant increase being projected for future years.  However, efforts to reform education of the health care workforce and redesign practice in the health care system need to be better aligned because change in one of these interacting systems inevitably influences the other.  Efforts to improve Interprofessional Education (IPE), or collaborative practice, independently have fallen short.  The IOM Committee felt that widespread adoption of a model of interprofessional education across the learning continuum is urgently needed.  An ideal model would retain the tenets of professional identity formation, while providing robust opportunities for interprofessional education and collaborative care.  Such a model would differentiate between learning outcomes per se and the individual, population, and system outcomes that provide the ultimate rationale for ongoing investment in health professions education.  With a refreshing global perspective, the Committee proposed that once tested, such a model could be adapted to fit the particular needs of higher- and lower-resource settings around the globe.  “It is no longer acceptable to think of either health or education in isolation.  The final model must accommodate the reality of today’s globalized community.”

            The Committee further noted that coordinated planning among educators, health system leaders, and policy makers is a prerequisite to creating an optimal learning environment and an effective health workforce.  Educators need to be cognizant of health system redesign efforts; while health system leaders need to recognize the realities of educating and training a competent health workforce.  Joint planning is especially important when health systems are undergoing rapid changes, as they are across much of the world today.  IPE is particularly affected by the need for joint planning because the practice environment is where much of the imprinting of concepts such as collaboration and effective teamwork takes place.  Despite calls for greater alignment, however, education reform is rarely well integrated with health system redesign.  After an extensive literature search, the Committee concluded that it was currently unable to find any model that sufficiently incorporated all of the components needed to guide future efforts.  A cautionary note: “Although there is widespread and growing belief that IPE may improve interprofessional collaboration, promote team-based health care delivery, and enhance personal and population health, definitive evidence linking IPE to desirable intermediate and final outcomes does not yet exist.”  Thus, the fun and excitement of becoming personally involved in the health care public policy process.

            The First Signs of Spring:  At this year’s inspirational State Leadership Conference (SLC), former APA Board member Josephine Johnson and I reflected upon how SLC is one of the highlights of APA.  “I’ve learned so much about advocacy and its importance – something we didn’t learn in graduate school.”  Fittingly, the focus was Practice Innovation.  Katherine Nordal: “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.  And health care is moving ahead – with or without psychology.  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.”  All is groovy.  Aloha,

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

 

SLOW DOWN, YOU MOVE TOO FAST

Give An Hour:  This spring we had the unique opportunity to attend Give an Hour's national conference highlighting their "Campaign to Change Direction" in the way that the nation talks about mental health.  First Lady Michelle Obama was the inspirational keynote speaker.  Other speakers included psychologists Barbara Van Dahlen, Founder and President of Give an Hour; Norman Anderson, Art Evans, and Randy Phelps.  Most memorable were the testimonials from veterans who had personally experienced the anxiety, depression, and suicidal ideation of PSTD.  Over 50 organizations were engaged that morning; the number now being in excess of 100.

Barbara: "Give an Hour's work these last 10 years has taught us a very important lesson.  The greatest barrier to ensuring proper mental health support for those who serve and their families is not a shortage of appropriately trained mental health professionals or the lack of effective treatments for specific conditions and concerns.  The greatest barrier to effectively addressing the mental health needs of those who serve is the same barrier that prevents civilians with mental health concerns from receiving proper care.  It is the same barrier that leads to 39,000 suicides each year in America, including the deaths of 22 veterans each day.  The greatest barrier to ensuring the mental health well-being of all of our citizens, civilians and military, is our culture itself.  The manner in which we view and respond to mental health prevents service members and their families, just as it prevents civilians, from recognizing and acknowledging the suffering that we see in ourselves and others.  Until we change our culture so that mental health is viewed in the same way we view physical health – as one of many important elements of being human – we will continue to fail those in need."  Mrs. Obama rhetorically asked: "Should not mental health be viewed in the same manner as cancer, diabetes, and other physical ailments?"  Barry Anton points out in his May Monitor Presidential column that 70 percent of primary-care visits stem from psychosocial factors.

"At the core of the campaign – and the cultural movement it is inspiring – is a plan to educate all Americans on the five signs of emotional suffering.  Just as we recognize the signs that someone may be having a heart attack, we can learn the signs that may indicate that someone we know is in emotional pain and needs our help.  And if we recognize these signs in others, we reach out, we connect, we offer to help.  By creating a common language and the recognition that we can all pay attention to our mental well-being, we have the opportunity to reduce suffering and build healthy communities (Barbara)."  Visit www.changedirection.org.  A truly impressive vision, one which highlights the importance of psychology becoming integrated into primary care, for both the profession and our clients.

            Another Exciting Vision:  The former chief academic affiliations officer for the Department of Veterans Affairs (VA), Malcolm Cox, chaired the recent IOM report Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes.  His report notes that much has changed over the past decade, necessitating new thinking.  Innovators then stressed the importance of patient-centered care; today, they think of patients as partners in health promotion and health care delivery.  Patients are now to be integral members of the care team, not solely patients to be treated; and the team is recognized as comprising a variety of health professionals.  This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models.

            The VA has a very impressive record of integrating education and clinical care.  Under Robert Zeiss's leadership (2005-2013), and continuing today under Kenneth Jones, psychology's post-doctoral training thrived with the annual number of funded positions increasing from 52 to 402, and with a significant increase being projected for future years.  However, efforts to reform education of the health care workforce and redesign practice in the health care system need to be better aligned because change in one of these interacting systems inevitably influences the other.  Efforts to improve Interprofessional Education (IPE), or collaborative practice, independently have fallen short.  The IOM Committee felt that widespread adoption of a model of interprofessional education across the learning continuum is urgently needed.  An ideal model would retain the tenets of professional identity formation, while providing robust opportunities for interprofessional education and collaborative care.  Such a model would differentiate between learning outcomes per se and the individual, population, and system outcomes that provide the ultimate rationale for ongoing investment in health professions education.  With a refreshing global perspective, the Committee proposed that once tested, such a model could be adapted to fit the particular needs of higher- and lower-resource settings around the globe.  "It is no longer acceptable to think of either health or education in isolation.  The final model must accommodate the reality of today's globalized community."

            The Committee further noted that coordinated planning among educators, health system leaders, and policy makers is a prerequisite to creating an optimal learning environment and an effective health workforce.  Educators need to be cognizant of health system redesign efforts; while health system leaders need to recognize the realities of educating and training a competent health workforce.  Joint planning is especially important when health systems are undergoing rapid changes, as they are across much of the world today.  IPE is particularly affected by the need for joint planning because the practice environment is where much of the imprinting of concepts such as collaboration and effective teamwork takes place.  Despite calls for greater alignment, however, education reform is rarely well integrated with health system redesign.  After an extensive literature search, the Committee concluded that it was currently unable to find any model that sufficiently incorporated all of the components needed to guide future efforts.  A cautionary note: "Although there is widespread and growing belief that IPE may improve interprofessional collaboration, promote team-based health care delivery, and enhance personal and population health, definitive evidence linking IPE to desirable intermediate and final outcomes does not yet exist."  Thus, the fun and excitement of becoming personally involved in the health care public policy process.

            The First Signs of Spring:  At this year's inspirational State Leadership Conference (SLC), former APA Board member Josephine Johnson and I reflected upon how SLC is one of the highlights of APA.  "I've learned so much about advocacy and its importance – something we didn't learn in graduate school."  Fittingly, the focus was Practice Innovation.  Katherine Nordal: "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.  And health care is moving ahead – with or without psychology.  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."  All is groovy.  Aloha,

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