SUBSTANTIVE CHANGE TAKES TIME, AND IS EXCITING:

The Fiscal Year 2016 budget for the Centers for Disease Control and Prevention (CDC) proclaims: "Obesity has increased substantially over the past few decades.  An estimated 36% (78.6 million) of adults and 17% (more than 12.7 million) of children have obesity.  Americans with obesity are at higher risk for developing hypertension, high cholesterol, type 2 diabetes, heart disease, and certain cancers especially earlier in life, and for premature death."  Obesity is projected to result in $147 billion in annual health care costs to the U.S. economy.  Today 61% of military personnel are either overweight or obese.  In May of 2010, the White House Task Force on Childhood Obesity submitted its report to the President entitled Solving the problem of childhood obesity within a generation.  The Task Force reported that overweight and obese children are more likely to become obese adults and estimated that obesity caused 112,000 deaths per year in the United States.  They further proffered that the current generation may be on track to have a shorter lifespan than their parents.  The President of the American Medical Association (AMA) recently described their proactive initiatives in this area at the Uniformed Services University of the Health Sciences (USUHS), having served more than 23 years in the U.S. Navy.  Addressing obesity should be a national priority for all health care professions.

            More than a decade ago, in April, 2004, the then-Director of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) testified before the U.S. Senate on the relationship between obesity and the environment.  "Environment and behavior intersect in fundamental ways, intersecting with our biology but also with each other.  In no area of public health is this more apparent than with the problem of obesity.  There is a growing body of literature that illustrates the negative physical and mental health effects of unregulated and poor urban, rural, and suburban development and planning.  These studies have documented increased rates of obesity, diabetes, depression, anxiety, and heart disease in these poorly developed areas….

"The NIEHS is designing a program as part of the trans-NIH obesity initiative which is designed to examine how the built environment affects obesity and the effectiveness of changes in community planning, design, and development in reducing the extent of obesity and associated comorbidities.  These intervention research projects will develop tools to characterize and measure individual and population-level indicators of healthful communities – and of residents' lifestyles and behaviors – that prevent or reduce obesity."

           From a public policy perspective, the Director's 2004 public health-oriented testimony was visionary.  This was at a time when psychology was working diligently to convince the leadership of the NIH that the behavioral sciences, and psychology in particular, could significantly contribute to the underlying NIH mission of advancing the health of the nation.  Over the past decade there has been an increasing acceptance of behavioral issues within NIH, even if some of it was a reluctant or grudging acceptance.  Much of the acceptance was fueled by the constant messages from Congressional champions of behavior, expressing their belief that behavior was a critical factor in health.  At the heart of this effort to convince the Congress to support behavioral health research was Alan Kraut, formerly with APA and recently retiring as CEO of the Association for Psychological Science (APS).  For decades, Alan was a most impressive, if not almost constant, presence on Capitol Hill, truly "making a difference."

            On September 15, 2015, President Obama signed the Executive Order "Using Behavioral Science Insights to Better Serve the American People," which Ron Wood thoughtfully brought to our attention.  "A growing body of evidence demonstrates that behavioral science insights – research findings from fields such as behavioral economics and psychology about how people make decisions and act on them – can be used to design government policies to better serve the American people.  Where Federal policies have been designed to reflect behavioral science insights, they have substantially improved outcomes for the individuals, families, communities, and businesses those policies serve….  By improving the effectiveness and efficiency of Government, behavioral science insights can support a range of national priorities, including helping workers to find better jobs; enabling Americans to lead longer, healthier lives; improving access to educational opportunities and support for success in school; and accelerating the transition to a low-carbon economy."

            The President went on to encourage his executive departments and agencies to identify policies, programs, and operations where applying behavioral science insights may yield substantial improvements in public welfare, program outcomes, and program cost effectiveness.  He urged, where possible, rigorously testing and evaluating the impact of behavioral science input and strengthening agency relationships with the research community to better use empirical findings from the behavioral sciences.  [The parallel to RxP with its long history of providing quality care at the federal and state level should be evident to the Division's membership.]

            Learning From The Past:  One of the most exciting aspects of being personally involved in the public policy process is the constant exposure to individuals who have "made a difference" because of their personal vision, dedication, and commitment to a seemingly "impossible" goal.  Former APA President Nick Cummings was unable to attend this year's convention in Toronto due to a previous commitment for the inauguration of his newest educational adventure.  Without question, one of Nick's most lasting contributions to the field has been the establishment of the California School of Professional Psychology (CSPP), now Alliant International University, with their alumni representing nearly half of the practicing psychologists in California.  "In August, the newly provisionally licensed free-standing doctoral graduate college in mental health, the first such in 23 years, began world-wide classes on the internet.  Our daughter Janet heads the Cummings Graduate Institute (CGI) which is the successor to Arizona State University's (ASU) Nicholas A. Cummings Doctor of Behavioral Health (DBH) program.  After seven highly successful years of turning out DBHs, with a spectacular employment rate in which four graduates are now CEOs of huge healthcare companies, a new ASU administration began moving the program more and more back into academic provincialism.  We successfully recreated our DBH into its free-standing status, and accomplished this within a year rather than the 10 years that had been predicted.  To apply a psychologist, social worker, counselor or nurse must have a master's degree, be licensed, and have at least seven years of successful practice.  The interest has been enthusiastic, allowing CGI to accept only the best of the best applicants."

            After returning from Toronto, we had the unique opportunity to hear Capt. (Ret.) Guy D. Gruters, USAF, share his experience with the USUHS community having been a Prisoner Of War in Vietnam for five years and three months, including at the notorious "Hanoi Hilton."  A graduate of the Air Force Academy, he has been awarded more than 30 combat medals having flown over 400 combat missions during the Vietnam War, and was twice shot down – the second time being captured by the Viet Cong.  As he described the torture he and his colleagues (including U.S. Senator John McCain) underwent -- physical and emotional -- and especially the extraordinarily long periods of isolation, the audience could well appreciate that very few could survive.  "You have heard of being kicked around or slapped around.  I never knew what that meant until prison camp."  "There were slightly over 3500 aircrew members shot down over North Vietnam in the years 1964 to 1973 who were not rescued.  In 1973, 591 POWs came home from all services and all countries in Southeast Asia of which 472 came home from North Vietnam.  The Russians and North Vietnamese tortured to death or killed in one way or another six out of every seven of us in North Vietnam."  Belief in God and family were the key to survival.  Ever so humble, after his talk Capt. (Ret.) Gruters had lunch with several faculty and students, including two Doctor of Nursing Practice (DNP) mental health nursing students, and agreed to be interviewed by psychology graduate students for a forthcoming publication.  The importance and relevance of psychology for those who put themselves in "harm's way" cannot be overstated.  Nick was a WWII paratrooper and since our last Division column, we learned that former APA and Division 55 President Ron Fox served in the National Guard.  Psychology should be proud of its uniformed services heritage.  Our colleagues have served the nation admirably.

            Closing Reflections:  When I reflect upon the vision and inner strength of these dedicated public servants, it gives me pause that today some seem to be trying to "punish" several of our academic colleagues, including destroying their careers, perhaps for example, for publicly accepting the invitation of the Department of Defense to visit Guantanamo Bay, per the Hoffman Report, without the APA governance having found any wrongdoing or malfeasance.  Universities are where ideas are to be critically debated; not where scholars or students are to personally attacked.  Equally important, providing everyone with Due Process – especially if one passionately disagrees with them -- is a fundamental value which psychology should never forsake.  Aloha,

Pat DeLeon, former APA President – Division 55 – October, 2015

 

ALOHA - Division 31 September column

“You Can Observe A Lot By Watching”

            I have been extremely fortunate to have attended almost all of the annual APA State Leadership conferences which are definitely one of the highlights of the year.  Katherine Nordal keeps raising critical issues which hopefully our State Associations appreciate and follow through on.  There can be no question that psychology must enthusiastically embrace its role as a health care profession, especially with the enactment of President Obama’s landmark Patient Protection and Affordable Care Act (ACA).  Unprecedented change is occurring which will require psychology to develop interprofessional skills, capitalize upon the continuing advances within the communications and technology fields, and develop data-based mental/behavioral health “best practice” protocols of care.

            At this year’s conference, David Ballard celebrated 10 years of Psychologically Healthy Workplace Award presentations where the best of business acumen has been recognized.  Health care represents a major element of our nation’s economy, estimated to be 18% of the Gross Domestic Product (GDP) and steadily growing.  As a nation we spend more on health care per person than any other country, without the expected quality outcomes.  In fact, Art Kellerman, formerly with the RAND Corporation and now Dean of America’s Medical School at USUHS, tweets: “U.S. healthcare system wastes more $$ each year on inefficient/inappropriate care than we annually spend on defense.”  Working closely with, and thereby educating, business leaders is definitely in the profession’s interest.

            Nursing has taken a visionary and very creative approach to this critical challenge.  With more than three million members, nursing represents the largest of the health care professions.  Several of their national organizations, including the American Nurses Association (ANA) and the American Academy of Nursing (AAN), have recently undertaken strategic campaigns to place their members on major policy boards at the federal and state level, as well as on those of relevant organizations, for example, on hospital Boards of Directors.  Their goal – 10,000 appointments by 2020.  They definitely will bring a distinctive and most positive perspective to critical policy deliberations.  The AAN effort is chaired by Angelia McBride, a fellow Purdue University graduate.  She is one of a number of nurse-psychologists who belong to APA, including former President Carol Goodheart.   We would rhetorically ask: “Whether our State Associations have capitalized upon this valuable resource within their own membership?”

            Barry Anton, our 2015 President, is himself a veteran and was an inspiration for the next generation when he graciously addressed our health policy seminar at USUHS earlier this year.  During the Toronto convention, Barry found the time in his extraordinarily busy schedule to join with Tom DeMaio in presenting the prestigious Karl F. Heiser Advocacy Awards.  Former President Ron Fox, grandfather of the RxP movement, served in the National Guard.   We again wonder: “How many of our State Association Presidents have personally served in the Armed Forces or the National Guard?”  Their views would be very informative in responding to the ongoing debate surrounding the Hoffman Report.  “Yogi” Berra, Baseball Hall of Fame.  Aloha,

 

Pat DeLeon, former APA President – Division 31 – September, 2015

 

“You Can Observe A Lot By Watching”

    I have been extremely fortunate to have attended almost all of the annual APA State Leadership conferences which are definitely one of the highlights of the year.  Katherine Nordal keeps raising critical issues which hopefully our State Associations appreciate and follow through on.  There can be no question that psychology must enthusiastically embrace its role as a health careprofession, especially with the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA).  Unprecedented change is occurring which will require psychology to develop interprofessional skills, capitalize upon the continuing advances within the communications and technology fields, and develop data-based mental/behavioral health "best practice" protocols of care.

            At this year's conference, David Ballard celebrated 10 years of Psychologically Healthy Workplace Award presentations where the best of business acumen has been recognized.  Health care represents a major element of our nation's economy, estimated to be 18% of the Gross Domestic Product (GDP) and steadily growing.  As a nation we spend more on health care per person than any other country, without the expected quality outcomes.  In fact, Art Kellerman, formerly with the RAND Corporation and now Dean of America's Medical School at USUHS, tweets: "U.S. healthcare system wastes more $$ each year on inefficient/inappropriate care than we annually spend on defense."  Working closely with, and thereby educating, business leaders is definitely in the profession's interest.

            Nursing has taken a visionary and very creative approach to this critical challenge.  With more than three million members, nursing represents the largest of the health care professions.  Several of their national organizations, including the American Nurses Association (ANA) and the American Academy of Nursing (AAN), have recently undertaken strategic campaigns to place their members on major policy boards at the federal and state level, as well as on those of relevant organizations, for example, on hospital Boards of Directors.  Their goal – 10,000 appointments by 2020.  They definitely will bring a distinctive and most positive perspective to critical policy deliberations.  The AAN effort is chaired by Angelia McBride, a fellow Purdue University graduate.  She is one of a number of nurse-psychologists who belong to APA, including former President Carol Goodheart.   We would rhetorically ask: "Whether our State Associations have capitalized upon this valuable resource within their own membership?"

            Barry Anton, our 2015 President, is himself a veteran and was an inspiration for the next generation when he graciously addressed our health policy seminar at USUHS earlier this year.  During the Toronto convention, Barry found the time in his extraordinarily busy schedule to join with Tom DeMaio in presenting the prestigious Karl F. Heiser Advocacy Awards.  Former President Ron Fox, grandfather of the RxP movement, served in the National Guard.   We again wonder: "How many of our State Association Presidents have personally served in the Armed Forces or the National Guard?"  Their views would be very informative in responding to the ongoing debate surrounding the Hoffman Report.  "Yogi" Berra, Baseball Hall of Fame.  Aloha,

 

Pat DeLeon, former APA President – Division 31 – September, 2015

 

Sent from my iPhone

ALOHA - Division 19 September 2015 column

TORONTO – HOME OF THE HOCKEY HALL OF FAME

            The 123^rd APA annual convention was exciting and Toronto is a beautiful city.  There were a number of very interesting symposia highlighting, for example, the unique needs of military families, and the increasing impact of technology on healthcare and education.  A Sunday panel described the difficulties civilian researchers have in accessing military families, primarily due to barriers imposed by the Departments of Defense (DoD) and Veterans Affairs (VA).  This reminded me of the Give an Hour event earlier in the year during which the highest levels of health leadership within those two agencies agreed that healthcare records must possess interoperability if only for “quality of care” reasons – the same policy position endorsed by the Congress and previous Departmental Secretaries – but which still remains unresolved.  Why is it that as a nation we continue to tolerate DoD/VA providers maintaining separate silo-based systems?  Give an Hour’s keynote speaker – First Lady Michelle Obama – clearly put Wounded Warriors first in her talk and challenged the audience to join their Campaign to Change Direction.  Yet, why is it the Society for Military Psychology and the VA psychology leadership still do not schedule regular meetings or collaborative programs?  Their beneficiaries are essentially the same, just at different stages in their life journeys.  Accordingly, on several occasions, I was particularly pleased to hear Division 19 President Tom Williams describe the importance of focusing upon the “bigger picture” and psychology’s fundamental mission.

            When pioneers Commander John Sexton and Lt. Commander Morgan Sammons graduated from the DoD psychopharmacology training program on June 17, 1994, they created a vision for psychology that very few had ever foreseen.  The military “established the legitimacy of a prescription-training program outside of traditional medical school, thus providing a strong answer to the traditional critique from psychiatrists....”  The civilian sector has responded and in Toronto, Beth Rom-Rymer described the Illinois Psychological Association’s RxP success; as well as her visionary efforts to engage graduate (and undergraduate) students in their training.  Judi Steinman’s training program is within a college of pharmacy, as APA Board member Linda Campbell had originally proposed and implemented for three years at the Georgia Psychological Association.  And, Tony Puente provided an historical overview, having served on the original APA Task Force on Psychopharmacology whose 1992 report proffered “the proposed new providers had the potential to dramatically improve patient care and make important new advances in treatment.”

            The Hoffman Report:  APA’s Past-President Nadine Kaslow and President-Elect Susan McDaniel were inspirational in chairing the Town Hall meeting addressing the Hoffman Report.  The number of concerned colleagues who attended was most impressive, as was their genuine enthusiasm for fundamental reform.  One might (or might not) agree with the view subsequently expressed in the national media by Anne Speckhard who described the sweeping ban on any involvement by psychologists in national security interrogations as a “knee-jerk” reaction that some members felt was sorely needed to restore APA’s reputation.  She reported that in 2006 and 2007, she worked in Iraq with Task Force 134 on a program to challenge ideologically committed Islamic extremists.  The idea was to try to engage detainees who had been exposed to, or adhered to, militant jihadi ideology in order to redirect them to other, nonviolent solutions.  She took extraordinary care to write the highest level of ethical care into her program, instilling in all she trained that prisoners must be treated with respect, care and dignity and not tricked or mistreated.  For her, the ban is simply sidestepping responsibility for what APA failed to do, and still has not done, in regard to those who took part in harsh interrogations or witnessed and abetted “soft” torture or so-called enhanced interrogation techniques.  In her view, those psychologists should have been, and should still be, called up on ethics charges and have their APA membership revoked.  “Banning involvement in what the government is doing is simply refusing to take a stand for what is right.”  At the Toronto Town Hall meeting, the membership was definitely engaged which, in my judgment, speaks very well for the future of the profession.

            But for The Timing – Providing a Different Perspective:  I was surprised when one of the participants at the Town Hall meeting received a standing ovation after stating he had over 500 signatures urging APA President Barry Anton to resign.  For decades, Barry has been a visionary spokesperson on behalf of our nation’s children and youth.  He is a veteran and personally appreciates the many contributions that military and VA psychologists have made to our nation.  Returning from the convention, I again carefully reviewed what the Hoffman Report actually said about his participation.  I concluded that if I had been President in 2015, rather than 2000, there is little question that the same individuals would have been demanding my resignation.  Having been involved in APA governance for nearly 25 years, I seriously doubt that I would have acted any differently than our then-APA Recording Secretary.

            The Report points out that Barry was involved in the selection of the 2005 PENS Task Force and as Board Liaison, participated in the Task Force meeting -- “but was involved substantially less than the others.”  From my perspective, he consistently was a voice of reason urging that all who might be concerned about the underlying issues be respectfully listened to and engaged.  For example, when it was proposed that the Board of Directors should adopt the PENS report as policy, he stated: “I’m not sure it can go out as policy without [Council of Representatives] approval.  The [Board] can certainly accept the report.”  Subsequently, when the Board declared an “emergency” – a step which, in retrospect, all agree was highly unusual – his efforts assured that the entire Board would appreciate the seriousness of their action.  Similarly, in response to the 2008 member-driven Petition Resolution, he appropriately informed senior APA staff that “he had been hearing concerns from Council regarding the Board’s instruction that the ballot be accompanied by pro and con statements.”  These are thoughtful responses which, in my judgement, were appropriate if not judicious.  I sincerely hope that the perspective and clarity of thought demonstrated by Tom Williams will ultimately be embraced by the vast majority of APA.  Aloha,

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

 

 

TORONTO – HOME OF THE HOCKEY HALL OF FAME

The 123^rd APA annual convention was exciting and Toronto is a beautiful city.  There were a number of very interesting symposia highlighting, for example, the unique needs of military families, and the increasing impact of technology on healthcare and education.  A Sunday panel described the difficulties civilian researchers have in accessing military families, primarily due to barriers imposed by the Departments of Defense (DoD) and Veterans Affairs (VA).  This reminded me of the Give an Hour event earlier in the year during which the highest levels of health leadership within those two agencies agreed that healthcare records must possess interoperability if only for "quality of care" reasons – the same policy position endorsed by the Congress and previous Departmental Secretaries – but which still remains unresolved.  Why is it that as a nation we continue to tolerate DoD/VA providers maintaining separate silo-based systems?  Give an Hour's keynote speaker – First Lady Michelle Obama – clearly put Wounded Warriors first in her talk and challenged the audience to join their Campaign to Change Direction.  Yet, why is it the Society for Military Psychology and the VA psychology leadership still do not schedule regular meetings or collaborative programs?  Their beneficiaries are essentially the same, just at different stages in their life journeys.  Accordingly, on several occasions, I was particularly pleased to hear Division 19 President Tom Williams describe the importance of focusing upon the "bigger picture" and psychology's fundamental mission.

            When pioneers Commander John Sexton and Lt. Commander Morgan Sammons graduated from the DoD psychopharmacology training program on June 17, 1994, they created a vision for psychology that very few had ever foreseen.  The military "established the legitimacy of a prescription-training program outside of traditional medical school, thus providing a strong answer to the traditional critique from psychiatrists...."  The civilian sector has responded and in Toronto, Beth Rom-Rymer described the Illinois Psychological Association's RxP success; as well as her visionary efforts to engage graduate (and undergraduate) students in their training.  Judi Steinman's training program is within a college of pharmacy, as APA Board member Linda Campbell had originally proposed and implemented for three years at the Georgia Psychological Association.  And, Tony Puente provided an historical overview, having served on the original APA Task Force on Psychopharmacology whose 1992 report proffered "the proposed new providers had the potential to dramatically improve patient care and make important new advances in treatment."

            The Hoffman Report:  APA's Past-President Nadine Kaslow and President-Elect Susan McDaniel were inspirational in chairing the Town Hall meeting addressing the Hoffman Report.  The number of concerned colleagues who attended was most impressive, as was their genuine enthusiasm for fundamental reform.  One might (or might not) agree with the view subsequently expressed in the national media by Anne Speckhard who described the sweeping ban on any involvement by psychologists in national security interrogations as a "knee-jerk" reaction that some members felt was sorely needed to restore APA's reputation.  She reported that in 2006 and 2007, she worked in Iraq with Task Force 134 on a program to challenge ideologically committed Islamic extremists.  The idea was to try to engage detainees who had been exposed to, or adhered to, militant jihadi ideology in order to redirect them to other, nonviolent solutions.  She took extraordinary care to write the highest level of ethical care into her program, instilling in all she trained that prisoners must be treated with respect, care and dignity and not tricked or mistreated.  For her, the ban is simply sidestepping responsibility for what APA failed to do, and still has not done, in regard to those who took part in harsh interrogations or witnessed and abetted "soft" torture or so-called enhanced interrogation techniques.  In her view, those psychologists should have been, and should still be, called up on ethics charges and have their APA membership revoked.  "Banning involvement in what the government is doing is simply refusing to take a stand for what is right."  At the Toronto Town Hall meeting, the membership was definitely engaged which, in my judgment, speaks very well for the future of the profession.

            But for The Timing – Providing a Different Perspective:  I was surprised when one of the participants at the Town Hall meeting received a standing ovation after stating he had over 500 signatures urging APA President Barry Anton to resign.  For decades, Barry has been a visionary spokesperson on behalf of our nation's children and youth.  He is a veteran and personally appreciates the many contributions that military and VA psychologists have made to our nation.  Returning from the convention, I again carefully reviewed what the Hoffman Report actually said about his participation.  I concluded that if I had been President in 2015, rather than 2000, there is little question that the same individuals would have been demanding my resignation.  Having been involved in APA governance for nearly 25 years, I seriously doubt that I would have acted any differently than our then-APA Recording Secretary.

            The Report points out that Barry was involved in the selection of the 2005 PENS Task Force and as Board Liaison, participated in the Task Force meeting -- "but was involved substantially less than the others."  From my perspective, he consistently was a voice of reason urging that all who might be concerned about the underlying issues be respectfully listened to and engaged.  For example, when it was proposed that the Board of Directors should adopt the PENS report as policy, he stated: "I'm not sure it can go out as policy without [Council of Representatives] approval.  The [Board] can certainly accept the report."  Subsequently, when the Board declared an "emergency" – a step which, in retrospect, all agree was highly unusual – his efforts assured that the entire Board would appreciate the seriousness of their action.  Similarly, in response to the 2008 member-driven Petition Resolution, he appropriately informed senior APA staff that "he had been hearing concerns from Council regarding the Board's instruction that the ballot be accompanied by pro and con statements."  These are thoughtful responses which, in my judgement, were appropriate if not judicious.  I sincerely hope that the perspective and clarity of thought demonstrated by Tom Williams will ultimately be embraced by the vast majority of APA.  Aloha,

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

 

HPA - September, 2015 column

THE 2015 APA TORONTO CONVENTION

            Toronto is a beautiful city and the weather was nearly perfect.  In between sessions, it was possible to wander through historic neighborhoods and, for example, Canada’s Walk of Fame highlighting actors, musicians, outstanding hockey players -- such as Maurice “Rocket” Richard and Gordie Howe -- as well as inventor Alexander Graham Bell.  The home of the Hockey Hall of Fame – and the Stanley Cup -- where the APA Presidential Reception was held on Saturday evening.  Division 42 President June Ching hosted an outstanding program (and social hour).  University of Hawaii graduate and former East-West Center fellow Laura Corlew shared her American Psychological Foundation (APF) visionary grant accomplishments in addressing risk perception regarding natural disasters and climate change in Hawaii and American Samoa.  Laura is one of several grantees that donors to APF make possible.  APF is in the middle of the Campaign to Transform the Future to increase its grant-making capacity.  Although APF grants approximately $800,000 annually, the Foundation can only support 10% of those who apply.  It is the Foundation’s hope that with this Campaign no worthy graduate student or early career psychologist will go without needed support.

            The APA Council of Representatives:  Council spent a considerable amount of time discussing and responding to the Hoffman report.  President-elect Susan McDaniel and Past-President Nadine Kaslow reported “The Council voted overwhelmingly to prohibit psychologists from participating in military and national security interrogations that operate outside the protection of the U.S. Constitution and military law.  The measure passed by a vote of 157-1, with 6 abstentions and 1 recusal….  The prohibition does not apply to domestic law enforcement interrogations or domestic detention settings where detainees are under the protection of the U.S. Constitution….”

            A number of important measures were passed, including one responding directly to the emphasis of the Affordable Care Act (ACA) on capitalizing upon the unprecedented developments occurring within technology in order to provide the highest possible quality of evidence-based health care.  Specifically, Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB), reported that Council endorsed their Psychology Interjurisdictional Compact (PSYPACT) “to facilitate telehealth and temporary face-to-face practice of psychology across jurisdictional boundaries.”  APA governance and the general membership had the opportunity to review this proposal.  The Board of Professional Affairs (BPA) proffered that PSYPACT “would effectively facilitate telepsychology practice described in the APA Guidelines for the Practice of Telepsychology (APA, 2013) as developed by the Joint Task Force for the Development of Telepsychology Guidelines, comprised of representatives from the APA, ASPPB, and the APA Insurance Trust (APAIT).”  That task force was co-chaired by Linda Campbell and Fred Millan, with the active participation of Trust CEO Jana Martin.

            ASPPB President Martha Storie noted “The PSYPACT will promote further cooperation and standardization of requirements among psychology licensing boards, and consequently, will serve to protect consumers of psychological services.”  An interstate compact is an agreement between states to enact legislation and enter into a contract for a specific, limited purpose or address a particular policy issue.  They are unique in their duality as statute and contract.  ASPPB will be working with the Council of State Governments (CSG) to create a resource kit that will serve as an informational document in support of this development.  The Compact will standardize practices that are currently jurisdiction-specific such as: (a) how many days of face-to-face practice are permitted in a state where the psychologist does not hold a license; and, (b) credentialing and authorization to practice telepsychology from an identified “home” state with a client in a state that has joined the Compact.  The PSYPACT would need to be adopted by state legislatures; the Compact would establish further rules and regulations regarding interjurisdictional practice.

            Steve reminded me that the compact approach psychology is developing is conceptually very similar to that being proposed by professional nursing (adopted by 25 states) and organized medicine (currently 11 states with more expected over the next year), with physical therapy and EMTs also exploring this approach.  ASPPB had received a grant from HRSA to facilitate their efforts to effectively address licensure mobility; telepsychology representing one aspect of this larger vision.  Change always takes considerable time and as the various health professions experiment with their implementation and political details, modifications will undoubtedly evolve.  In Toronto, I was particularly pleased to see Deborah Baker, Ken Drude, and Marlene Maheu continuing their impressive efforts to educate the grassroots membership.  Ken chaired the Ohio Psychological Association committee that developed the first psychological association telepsychology guidelines back in 2008.

            The Obama Administration:  In July, the White House released its report Occupational Licensing: A Framework for Policymakers, which was prepared by the Department of the Treasury Office of Economic Policy, the Council of Economic Advisers, and the Department of Labor.  Fundamental issues surrounding the licensure of health care professionals were addressed throughout the report, including licensure mobility and variations in professional scopes of practice within the states.  “While quality can be defined in many ways and is often difficult to measure, the evidence on licensing’s effect on prices is unequivocal: many studies find that more restrictive licensing laws lead to higher prices for consumers.”  “(S)ince each State sets its own licensing requirements, these often vary across State lines, and licensed individuals seeking to move to another State often discover that they must meet new qualifications (such as education, experience, training, testing, etc.) if they want to continue working in their occupation.”  “Licensing reform takes place at the State level, but Federal resources can help to incentivize State collaboration.”

            The White House reported increasing review at the State level of health care scopes of practice in a more comprehensive manner, citing California, Colorado, Pennsylvania, New Mexico, and Minnesota.  “Connecticut’s State legislature conducted a particularly thorough 2009 review of scope of practice for the health care professions, including comparisons with regulatory models from other States.”  And, “According to the Pew Health Professions Committee report in 1995, policymakers should endeavor to allow practitioners to offer services to the full extent of their competency and knowledge, even if this means that multiple professions are licensed to offer overlapping services.”  Enumerating Licensing Best Practices, the report urged States to: “Ensure that Licensing Restrictions are Closely Targeted to Protecting Public Health and Safety, and are Not Overly Broad or Burdensome.”  “Scope of practice has long been a particular focus in the health care context, in large part because of concerns about access to primary care.  Current scope of practice laws for advanced practice registered nurses – nurses such as nurse practitioners (NPs) with master’s degrees or more – vary dramatically by State, both in terms of their substantive content and the level of specificity that they provide.  But State-level evidence suggests that easing scope of practice laws for APRNs represents a viable means of increasing access to certain primary care services.  Research finds that APRNs can provide a broad range of primary care services to patients as effectively as physicians.”  This movement has even expanded to the legal profession with the Supreme Court of Washington State adopting a rule in 2012 creating a new category of legal practitioners – limited license legal technicians (LLLTs).  The key for psychology is: “Who is having this dialogue?”  Fundamentally, they are national/international experts who are passionately interested in our nation’s financial future; not individuals who are vested in their own profession’s status.

           Dramatic change is coming to our nation’s health care environment and psychology is well positioned for the future.  A closing reflection -- I was very pleased to see the standing ovation which Steven Reisner and his colleagues Stephen Soldz and Jean Maria Arrigo received at the Toronto Town Hall meeting addressing the Hoffman report.  Well-deserved tributes.  Aloha,

Pat DeLeon, former APA President – Hawaii Psychological Association – September, 2015

 

 

THE 2015 APA TORONTO CONVENTION

Toronto is a beautiful city and the weather was nearly perfect.  In between sessions, it was possible to wander through historic neighborhoods and, for example, Canada's Walk of Fame highlighting actors, musicians, outstanding hockey players -- such as Maurice "Rocket" Richard and Gordie Howe -- as well as inventor Alexander Graham Bell.  The home of the Hockey Hall of Fame – and the Stanley Cup -- where the APA Presidential Reception was held on Saturday evening.  Division 42 President June Ching hosted an outstanding program (and social hour).  University of Hawaii graduate and former East-West Center fellow Laura Corlew shared her American Psychological Foundation (APF) visionary grant accomplishments in addressing risk perception regarding natural disasters and climate change in Hawaii and American Samoa.  Laura is one of several grantees that donors to APF make possible.  APF is in the middle of the Campaign to Transform the Future to increase its grant-making capacity.  Although APF grants approximately $800,000 annually, the Foundation can only support 10% of those who apply.  It is the Foundation's hope that with this Campaign no worthy graduate student or early career psychologist will go without needed support.

            The APA Council of Representatives:  Council spent a considerable amount of time discussing and responding to the Hoffman report.  President-elect Susan McDaniel and Past-President Nadine Kaslow reported "The Council voted overwhelmingly to prohibit psychologists from participating in military and national security interrogations that operate outside the protection of the U.S. Constitution and military law.  The measure passed by a vote of 157-1, with 6 abstentions and 1 recusal….  The prohibition does not apply to domestic law enforcement interrogations or domestic detention settings where detainees are under the protection of the U.S. Constitution…."

            A number of important measures were passed, including one responding directly to the emphasis of the Affordable Care Act (ACA) on capitalizing upon the unprecedented developments occurring within technology in order to provide the highest possible quality of evidence-based health care.  Specifically, Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB), reported that Council endorsed their Psychology Interjurisdictional Compact (PSYPACT) "to facilitate telehealth and temporary face-to-face practice of psychology across jurisdictional boundaries."  APA governance and the general membership had the opportunity to review this proposal.  The Board of Professional Affairs (BPA) proffered that PSYPACT "would effectively facilitate telepsychology practice described in the APA Guidelines for the Practice of Telepsychology (APA, 2013) as developed by the Joint Task Force for the Development of Telepsychology Guidelines, comprised of representatives from the APA, ASPPB, and the APA Insurance Trust (APAIT)."  That task force was co-chaired by Linda Campbell and Fred Millan, with the active participation of Trust CEO Jana Martin.

            ASPPB President Martha Storie noted "The PSYPACT will promote further cooperation and standardization of requirements among psychology licensing boards, and consequently, will serve to protect consumers of psychological services."  An interstate compact is an agreement between states to enact legislation and enter into a contract for a specific, limited purpose or address a particular policy issue.  They are unique in their duality as statute and contract.  ASPPB will be working with the Council of State Governments (CSG) to create a resource kit that will serve as an informational document in support of this development.  The Compact will standardize practices that are currently jurisdiction-specific such as: (a) how many days of face-to-face practice are permitted in a state where the psychologist does not hold a license; and, (b) credentialing and authorization to practice telepsychology from an identified "home" state with a client in a state that has joined the Compact.  The PSYPACT would need to be adopted by state legislatures; the Compact would establish further rules and regulations regarding interjurisdictional practice.

            Steve reminded me that the compact approach psychology is developing is conceptually very similar to that being proposed by professional nursing (adopted by 25 states) and organized medicine (currently 11 states with more expected over the next year), with physical therapy and EMTs also exploring this approach.  ASPPB had received a grant from HRSA to facilitate their efforts to effectively address licensure mobility; telepsychology representing one aspect of this larger vision.  Change always takes considerable time and as the various health professions experiment with their implementation and political details, modifications will undoubtedly evolve.  In Toronto, I was particularly pleased to see Deborah Baker, Ken Drude, and Marlene Maheu continuing their impressive efforts to educate the grassroots membership.  Ken chaired the Ohio Psychological Association committee that developed the first psychological association telepsychology guidelines back in 2008.

            The Obama Administration:  In July, the White House released its report Occupational Licensing: A Framework for Policymakers, which was prepared by the Department of the Treasury Office of Economic Policy, the Council of Economic Advisers, and the Department of Labor.  Fundamental issues surrounding the licensure of health care professionals were addressed throughout the report, including licensure mobility and variations in professional scopes of practice within the states.  "While quality can be defined in many ways and is often difficult to measure, the evidence on licensing's effect on prices is unequivocal: many studies find that more restrictive licensing laws lead to higher prices for consumers."  "(S)ince each State sets its own licensing requirements, these often vary across State lines, and licensed individuals seeking to move to another State often discover that they must meet new qualifications (such as education, experience, training, testing, etc.) if they want to continue working in their occupation."  "Licensing reform takes place at the State level, but Federal resources can help to incentivize State collaboration."

            The White House reported increasing review at the State level of health care scopes of practice in a more comprehensive manner, citing California, Colorado, Pennsylvania, New Mexico, and Minnesota.  "Connecticut's State legislature conducted a particularly thorough 2009 review of scope of practice for the health care professions, including comparisons with regulatory models from other States."  And, "According to the Pew Health Professions Committee report in 1995, policymakers should endeavor to allow practitioners to offer services to the full extent of their competency and knowledge, even if this means that multiple professions are licensed to offer overlapping services."  Enumerating Licensing Best Practices, the report urged States to: "Ensure that Licensing Restrictions are Closely Targeted to Protecting Public Health and Safety, and are Not Overly Broad or Burdensome."  "Scope of practice has long been a particular focus in the health care context, in large part because of concerns about access to primary care.  Current scope of practice laws for advanced practice registered nurses – nurses such as nurse practitioners (NPs) with master's degrees or more – vary dramatically by State, both in terms of their substantive content and the level of specificity that they provide.  But State-level evidence suggests that easing scope of practice laws for APRNs represents a viable means of increasing access to certain primary care services.  Research finds that APRNs can provide a broad range of primary care services to patients as effectively as physicians."  This movement has even expanded to the legal profession with the Supreme Court of Washington State adopting a rule in 2012 creating a new category of legal practitioners – limited license legal technicians (LLLTs).  The key for psychology is: "Who is having this dialogue?"  Fundamentally, they are national/international experts who are passionately interested in our nation's financial future; not individuals who are vested in their own profession's status.

           Dramatic change is coming to our nation's health care environment and psychology is well positioned for the future.  A closing reflection -- I was very pleased to see the standing ovation which Steven Reisner and his colleagues Stephen Soldz and Jean Maria Arrigo received at the Toronto Town Hall meeting addressing the Hoffman report.  Well-deserved tributes.  Aloha,

Pat DeLeon, former APA President – Hawaii Psychological Association – September, 2015