THERE ARE NO PROBLEMS WE CANNOT SOLVE TOGETHER
This summer I was invited to the Florida Psychological Association (FPA) annual convention. It was extremely exciting to see President Lori Butts focus her Town Hall luncheon on the unprecedented changes occurring within the Florida health care environment. As speaker after speaker described what they have been doing over the past several years – for example, utilizing telehealth/telepsychology within the Veterans Administration (VA) or working within the judicial system – it became evident that FPA is well positioned to capitalize upon the monumental changes envisioned by President Obama’s Patient Protection and Affordable Care Act (ACA). Steve Ragusea and his son Tony, both of whom were formally recognized at the subsequent awards ceremony, discussed the maturing Florida prescriptive authority (RxP) task force – which is being actively supported by Illinois/Florida resident Beth Rom-Rymer. “Illinois has been a great success story for RxP. Over 640 psychologists throughout the state came together to lobby for our bill. We now have over 50 psychologists in training and two licensed prescribing psychologists on our licensing board.” Forensic, neuropsychology, and active involvement in public education were several of the topics addressed throughout the convention.
The enthusiasm and energy demonstrated by the FPA membership were very refreshing and reminded me of Katherine Nordal’s charge at this year’s annual State Leadership Conference: “To be innovators we need to shake off some old ways of thinking about traditional practice models. We need to shake off the negative attitudes some of our colleagues have about what’s happening in health care. That world is changing. Health care is moving ahead – with or without psychology. 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.” My message was that psychology has become one of our nation’s bone fide healthcare professions. We must adapt to the healthcare environment of tomorrow.
An underlying foundation of the ACA is fostering the importance of providing patient-centered, best-practice oriented, holistic care within an interdisciplinary collaborative model. To be successful, psychology must learn what other disciplines are doing. FPA’s leadership and membership have clearly expressed their faith in the profession’s ability to adjust to the new healthcare environment and FPA is nicely positioning itself to move into that quickly emerging future in order to seize the opportunities that will evolve.
The Legal Profession: Dina Shek is the Legal Director of Hawaii’s Medical-Legal Partnership (MLP) at the Kokua Kalihi Valley Federally Qualified Community Health Center (FQCHC) on Oahu, Hawaii -- which seeks to address the holistic needs of a number of traditionally underserved residents from throughout the Pacific Basin region, the Philippines, and Native Hawaiians. “‘I can’t imagine practicing medicine without a lawyer on my team!’ stated Dr. Alicia Turlington, MLP Medical Director, in the national Community Health Forum. She continued: ‘I think I’d be practicing substandard care. Not asking questions about housing, benefits and food would feel wrong, but so would asking if I couldn’t do anything about it. Our lawyers help me treat those things.’
“In 2004, Dr. Barry Zuckerman and other MLP advocates published ‘Why Pediatricians Need Lawyers to Keep Children Healthy.’ As a law student at the time, this helped inspire me to start Hawaii’s first MLP for Children. Now in our seventh year, our MLP addresses systemic advocacy issues while building on our work that provides free legal services on-site at community health clinic settings. Co-location is not enough, however – the key is integration. Integration means listening to patients’ stories, promoting their self-advocacy skills, and supporting community-led policy efforts. True collaboration means building relationships with providers, discussing trends and policy changes, and sharing stories of success and possible solutions. At times, building trust with patients means doing things that don’t necessarily appear ‘lawyerly’ – such as completing Head Start applications, making food bank referrals, and reviewing clients’ mail. People then will trust you with a food stamp termination letter or the employment discrimination story burdening a single mother’s soul.
“By collaborating at the place where low-income people get their healthcare, MLP attorneys provide ‘legal care’ to enhance health and family well-being. HRSA now recognizes the value of legal care, and recently included ‘legal services’ as an ‘enabling service’ eligible for community health funding. Pediatricians frequently uncover health-harming legal needs, but doctors are limited in their capacity to address non-medical problems. The MLP model ensures that health centers can address all the most pressing needs of their patients. Dr. Turlington’s words merit repeating: ‘I can’t imagine practicing medicine without a lawyer on my team.’”
The MLP for Children is a project of the William S. Richardson School of Law and is the leading clinical project for the Health Law Policy Center. Appropriately, the late-Chief Justice Richardson was Native Hawaiian and has authored some of the most far-reaching legal decisions affecting Native Hawaiians and their cultural relationship with the land. Currently MLPs exist in 235 health institutions in 38 states, with a national network. The American Bar Association and American Medical Association have passed national resolutions in support of this model. Dina has expanded her efforts to another Hawaii FQCHC, one serving an extraordinary number of Native Hawaiians in rural Oahu, as well as developed ongoing discussions with the Hawai’i Primary Care Association. Twice-weekly free legal advocacy clinics are hosted, as well as numerous professional training and educational workshops for healthcare providers, including students in nursing, social work, psychology, and medicine.
Clinical Pharmacy: Following up on a National Governors Association (NGA) 2015 policy paper, “The Expanding Role of Pharmacists in a Transformed Health Care System,” the National Alliance of State Pharmacy Associations (NASPA) convened a workshop to develop recommendations for what elements of collaborative practice authority should appropriately be defined under state law and/or regulations, and what should best be left to be determined between pharmacists and other practitioners when developing their specific collaborative practice arrangements (CPA). Noting that state laws and regulations authorizing CPAs are highly variable, the underlying key issues were: What is in the best interest of the patient and, Is the recommendation aligned with pharmacists’ considerable education and training? The participants felt “Any practitioner with prescriptive authority may collaborate with pharmacists using a CPA.” Further, “All prescription drugs, including controlled substances, may be included within pharmacists’ collaborative practice authority.” The workgroup took the approach that rapid innovation in education, training, technology, and evidence-based guidelines necessitate a collaborative practice framework that is flexible and facilitates innovation in care delivery.
Art Kellerman, Dean of America’s Medical School at USUHS, recently Tweeted: “U.S. healthcare system wastes more $$ each year on inefficient/inappropriate care than we annually spend on defense.” There are no problems we cannot solve together and very few that we can solve by ourselves. Aloha,
Pat DeLeon, former APA President – Division 42 – August, 2015
