ALOHA - Division 55 Fall column

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

 

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

 

Sent from my iPhone

Division 18 Fall column

ON THE SHOULDERS OF GIANTS

            Honoring Visionary Colleagues:  During our APA conventions, I enjoy attending the APF/APA Awards ceremonies, reflecting upon the outstanding accomplishments of our colleagues over the years.  In Toronto, Division 18 Fellow Walter Penk received the APF Gold Medal Award for Life Achievement in the Practice of Psychology, recognizing his distinguished career and enduring contributions for advancing professional practice.  His dedication and leadership at various federal and state agencies, as well as in academic settings, has significantly improved the lives of numerous veterans and Wounded Warriors, inspiring resiliency and post-traumatic growth.  Walter was among the first to publish clinical work identifying PTSD, as well as addressing the need to consider issues of diversity among ethnic groups when looking at PTSD.  We were proud that under the Presidency of Femina Varghese, Division 18 honored two members of the Psychological Services editorial team, Lisa Kearney and Phil Magaletta, for their tireless inspirational leadership.  With these visionary mentors, the future for public service psychology looks very bright.

            At the American Psychological Foundation (APF) Toronto reception, former East-West Center Fellow and Visionary Grant recipient Kate Corlew provided an overview of her research addressing risk perception regarding natural disasters and climate change in Hawaii and American Samoa.  “Many communities in the Pacific Islands Region are vulnerable now to the impacts of climate change.  The extent of the impacts varies from place to place, but what remains true is that the impacts do not occur in a vacuum – they accumulate and exacerbate each other and other disaster events and environmental hazards.  My project was based on Maui and American Samoa.  Both sites experience the accumulated effects of disasters and hazards.  Maui has experienced increased rates of extreme drought punctuated by heavy storms (as opposed to the regular rainy and dry seasons).  Secondary impacts from fluctuating between extremes include wildfire and dusty air during drought, and floods and mudslides during storms.  American Samoa has been hit by a number of disasters in the last six years – a devastating tsunami that destroyed villages and killed many people, followed by multiple hurricanes.  American Samoa is experiencing and projected to continue to experience compounding disasters.

            “My research compared the psychological experiences of disaster recovery in the two sites (minor emergency events in Maui and large-scale disasters in American Samoa).  Through a series of surveys, interviews, and community workshops, I explored psychological recovery, risk perception for future disasters and for climate change, and preparedness (emergency kits, plans, etc.) for future disasters.  I found that having experienced a large scale disaster was the best predictor for taking preparedness actions against future disasters.  Surviving a disaster was a better predictor than profession (i.e., disaster and climate change professionals were no more likely than other participants to have an emergency kit and plan in place than anyone else, unless they had personally experienced disasters) and was a better predictor than experiencing small-scale hazards that were inconveniently damaging but not devastating (e.g., a mudslide that blocked roads but did not kill anyone.)

            “During the interviews and community workshops, I gathered stories and advice from community members, disaster and climate change professionals, and community leaders about disaster preparedness education in the focal communities.  Using disaster preparedness guidelines from the American Red Cross and Ready.Gov, I developed community preparedness handbooks for the focal communities.  The handbooks included simple step-by-step guides for preparedness planning, as well as stories from their community about disaster events, hazards, risk, and preparedness.  Over 1,000 handbooks were disseminated for free back into communities (funded by the APF Visionary Grant), including handbooks in English and Samoan to American Samoa.  I have received requests from both sites to hold more workshops.  I am also beginning to develop a similar program of research and community education in Maine, where I am now located.”  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, only 10% of those who apply can be supported.  It is the Foundation’s hope that with this Campaign no worthy graduate student or early career psychologist will go without needed support.  Psychology’s visionaries can make a real difference in the lives of our nation’s citizens.

            Change Can Be Unsettling:  The Senate Appropriations Committee estimates the Department of Veterans Affairs (VA) is responsible for providing care to approximately 48.3 million Americans, or 15% of the nation’s population.  The VA has the nation’s largest integrated healthcare system, consisting of 167 medical centers, 1,018 community-based outpatient clinics, 300 Vet centers, and 135 community-based living centers.  This year the Committee noted: “Congress authorized the employment of licensed professional mental health counselors [LPMHC] and marriage and family therapists [MFT] by VA.  However, the two professions comprise less than 1 percent of the VA behavioral health workforce despite representing 40 percent of the overall [nation’s] independent practice behavioral health workforce….  The Department is directed to report… on the status of hiring additional LPMHC and MFT professionals and detailing how many are currently enrolled and planned to be enrolled in VA’s mental health professional trainee program.”  Further, “The Committee encourages the Department to consider the expanded use of physician assistants [PAs] specializing in psychiatric care to address the mental health provider gap.  PAs provide high quality, cost-effective medical care and are held to the same standard of healthcare delivery as their physician colleagues.”

            I recently had the opportunity to read the thought-provoking book Building School-Based Collaborative Mental Health Teams: A Systems Approach to Student Achievement by Kathleen Laundy.  She is a psychologist who is also a MFT.  It is important for practitioners who are concerned about the future of their profession to understand the experiences of the other behavioral health professions, rather than remaining within isolated professional silos.  Our colleague describes the impressive contributions that MFTs have made within the Connecticut school system and their increasingly successful efforts to develop a national grass-roots support network.  Her case examples are vivid illustrations of how MFTs are making a real difference in individual student lives – which, of course, is the key to political success.

            This is at a time when the Obama Administration is raising fundamental issues regarding the consequences of restrictive licensure for health care professionals, including limitations on licensure mobility and variations in professional scopes of practice within the states.  “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.”  The Administration notes that this trend has expanded to the legal profession with the Supreme Court of Washington State in 2012 adopting a rule creating a new category of legal practitioners – limited license legal technicians (LLLTs).  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 (Occupational Licensing: A Framework for Policymakers).”   Aloha,

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

 

ON THE SHOULDERS OF GIANTS

Honoring Visionary Colleagues:  During our APA conventions, I enjoy attending the APF/APA Awards ceremonies, reflecting upon the outstanding accomplishments of our colleagues over the years.  In Toronto, Division 18 Fellow Walter Penk received the APF Gold Medal Award for Life Achievement in the Practice of Psychology, recognizing his distinguished career and enduring contributions for advancing professional practice.  His dedication and leadership at various federal and state agencies, as well as in academic settings, has significantly improved the lives of numerous veterans and Wounded Warriors, inspiring resiliency and post-traumatic growth.  Walter was among the first to publish clinical work identifying PTSD, as well as addressing the need to consider issues of diversity among ethnic groups when looking at PTSD.  We were proud that under the Presidency of Femina Varghese, Division 18 honored two members of the Psychological Services editorial team, Lisa Kearney and Phil Magaletta, for their tireless inspirational leadership.  With these visionary mentors, the future for public service psychology looks very bright.

            At the American Psychological Foundation (APF) Toronto reception, former East-West Center Fellow and Visionary Grant recipient Kate Corlew provided an overview of her research addressing risk perception regarding natural disasters and climate change in Hawaii and American Samoa.  "Many communities in the Pacific Islands Region are vulnerable now to the impacts of climate change.  The extent of the impacts varies from place to place, but what remains true is that the impacts do not occur in a vacuum – they accumulate and exacerbate each other and other disaster events and environmental hazards.  My project was based on Maui and American Samoa.  Both sites experience the accumulated effects of disasters and hazards.  Maui has experienced increased rates of extreme drought punctuated by heavy storms (as opposed to the regular rainy and dry seasons).  Secondary impacts from fluctuating between extremes include wildfire and dusty air during drought, and floods and mudslides during storms.  American Samoa has been hit by a number of disasters in the last six years – a devastating tsunami that destroyed villages and killed many people, followed by multiple hurricanes.  American Samoa is experiencing and projected to continue to experience compounding disasters.

            "My research compared the psychological experiences of disaster recovery in the two sites (minor emergency events in Maui and large-scale disasters in American Samoa).  Through a series of surveys, interviews, and community workshops, I explored psychological recovery, risk perception for future disasters and for climate change, and preparedness (emergency kits, plans, etc.) for future disasters.  I found that having experienced a large scale disaster was the best predictor for taking preparedness actions against future disasters.  Surviving a disaster was a better predictor than profession (i.e., disaster and climate change professionals were no more likely than other participants to have an emergency kit and plan in place than anyone else, unless they had personally experienced disasters) and was a better predictor than experiencing small-scale hazards that were inconveniently damaging but not devastating (e.g., a mudslide that blocked roads but did not kill anyone.)

            "During the interviews and community workshops, I gathered stories and advice from community members, disaster and climate change professionals, and community leaders about disaster preparedness education in the focal communities.  Using disaster preparedness guidelines from the American Red Cross and Ready.Gov, I developed community preparedness handbooks for the focal communities.  The handbooks included simple step-by-step guides for preparedness planning, as well as stories from their community about disaster events, hazards, risk, and preparedness.  Over 1,000 handbooks were disseminated for free back into communities (funded by the APF Visionary Grant), including handbooks in English and Samoan to American Samoa.  I have received requests from both sites to hold more workshops.  I am also beginning to develop a similar program of research and community education in Maine, where I am now located."  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, only 10% of those who apply can be supported.  It is the Foundation's hope that with this Campaign no worthy graduate student or early career psychologist will go without needed support.  Psychology's visionaries can make a real difference in the lives of our nation's citizens.

            Change Can Be Unsettling:  The Senate Appropriations Committee estimates the Department of Veterans Affairs (VA) is responsible for providing care to approximately 48.3 million Americans, or 15% of the nation's population.  The VA has the nation's largest integrated healthcare system, consisting of 167 medical centers, 1,018 community-based outpatient clinics, 300 Vet centers, and 135 community-based living centers.  This year the Committee noted: "Congress authorized the employment of licensed professional mental health counselors [LPMHC] and marriage and family therapists [MFT] by VA.  However, the two professions comprise less than 1 percent of the VA behavioral health workforce despite representing 40 percent of the overall [nation's] independent practice behavioral health workforce….  The Department is directed to report… on the status of hiring additional LPMHC and MFT professionals and detailing how many are currently enrolled and planned to be enrolled in VA's mental health professional trainee program."  Further, "The Committee encourages the Department to consider the expanded use of physician assistants [PAs] specializing in psychiatric care to address the mental health provider gap.  PAs provide high quality, cost-effective medical care and are held to the same standard of healthcare delivery as their physician colleagues."

            I recently had the opportunity to read the thought-provoking book Building School-Based Collaborative Mental Health Teams: A Systems Approach to Student Achievement by Kathleen Laundy.  She is a psychologist who is also a MFT.  It is important for practitioners who are concerned about the future of their profession to understand the experiences of the other behavioral health professions, rather than remaining within isolated professional silos.  Our colleague describes the impressive contributions that MFTs have made within the Connecticut school system and their increasingly successful efforts to develop a national grass-roots support network.  Her case examples are vivid illustrations of how MFTs are making a real difference in individual student lives – which, of course, is the key to political success.

            This is at a time when the Obama Administration is raising fundamental issues regarding the consequences of restrictive licensure for health care professionals, including limitations on licensure mobility and variations in professional scopes of practice within the states.  "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."  The Administration notes that this trend has expanded to the legal profession with the Supreme Court of Washington State in 2012 adopting a rule creating a new category of legal practitioners – limited license legal technicians (LLLTs).  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 (Occupational Licensing: A Framework for Policymakers)."   Aloha,

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

 

Sent from my iPhone

FW: [DIVOFFICERS] “NEW APA POLICY BANS PSYCHOLOGIST PARTICIPATION ….”

Mahalo

 

From: APA Division Officers list [mailto:DIVOFFICERS@LISTS.APA.ORG] On Behalf Of Ronald Wood
Sent: Monday, October 12, 2015 7:14 PM
To: DIVOFFICERS@LISTS.APA.ORG
Subject: [DIVOFFICERS] "NEW APA POLICY BANS PSYCHOLOGIST PARTICIPATION …."

 

Pat DeLeon (an APA past president) writes to Division 1 discussing Hoffman Report:

" "NEW APA POLICY BANS PSYCHOLOGIST PARTICIPATION …."

The APA State Leadership Conference (SLC):  One of the highlights of my year has always been the annual Practice Directorate/Practice Organization State Leadership Conference (SLC), where Katherine Nordal exposes approximately 550+ state association leaders from around the country to the changes evolving within the nation's health care system, as well as the world of national politics.  One of her subtle reoccurring themes is the importance of the attendees getting to know their local media on a personal basis, in order to educate them about the field of psychology and our collective potential for having a positive impact upon society's most pressing needs.  Dan Ullman, for example, recently shared with us an article from the Star-Herald graphically describing the compelling need for quality mental health care throughout the rural areas of Nebraska.  This will undoubtedly be used by the Nebraska Psychological Association in furtherance of their contemplated RxP legislation.  Earlier this year, I was invited by President Lori Butts to participate in the Florida Psychological Association annual meeting where their ongoing efforts to collaborate with the media were highlighted.  And, I am well aware that the Hawaii Psychological Association hosts an annual media award.  There can be no question that the media has a major impact upon society's appreciation of psychology.  During our Toronto convention, the impact of the New York Times coverage (as well as that of other major news organizations) of the Hoffman Report was quite evident.

            The Hoffman Report:  I have had the extremely good fortune to have been involved in the APA governance for approximately a quarter of a century.  It was a wonderful experience – addressing important agendas; working with fantastic colleagues; and a real chance to "make a difference."  Having been interviewed for the Hoffman Report at the invitation of Past President Nadine Kaslow, I read it carefully several times.  As the Report indicated, the specific question the APA Board of Directors asked the authors to address was: "whether APA officials colluded with DoD, CIA, or other government officials 'to support torture.'"

In my judgment, the discussion regarding the Department of Defense (DoD) psychopharmacology (RxP) training program was very accurate.  "The demonstration project thus served a crucial unlocking function for psychology and APA, since it established the legitimacy of a prescription-training program outside of traditional medical school, thus providing a strong answer to the traditional critique from psychiatrists that the only way to be trained in prescribing psychiatric medication was to graduate from a traditional four-year medical school.  We do not believe that by 2005, APA officials were realistically seeking or expecting anything further from DoD on the topic of prescription privileges.  Nor do we believe that APA officials actually worried that a failure to curry favor with DoD would cause DoD to reverse course on prescription privileges by, for instance, disallowing previously-certified psychologists from continuing to prescribe medication when they treated DoD personnel."

            The convention Town Hall meeting focusing upon the Report, chaired by Nadine and President-Elect Susan McDaniel, was most impressive.  More colleagues passionately participated than I had anticipated and they were definitely engaged.  My sincerest appreciation and congratulations to Steven Reisner and his colleagues Stephen Soldz and Jean Maria Arrigo for their personal commitment to having APA address this important issue.  And yet, as I listened to the audience and reviewed the comments being made on various list-serves, I must conclude that if I had been President in 2015, rather than 2000, there is little question that the same individuals would be demanding my resignation.  That realization fosters an entirely different perspective.

            Over the years, I have served in various capacities within the APA governance.  As an elected (or appointed) member of various boards and committees, including three terms on the APA Board of Directors and President in 2000, I relied heavily upon the good judgment of staff and volunteers.  I worked closely with a number of the individuals mentioned in the Hoffman Report and have the highest respect for them and their professional integrity.  For example, during my Presidential year APA CEO Ray Fowler unfortunately suffered serious health problems and Mike Honaker did an outstanding job in his absence.  Similarly, no one has contributed more to APA's smooth functioning than Judy Strassburger during her 40 years of service.  I will never forget how helpful Rhea Farberman was to then-President Norine Johnson during the chaos surrounding 9/11 and her efforts to address the psychological needs of our nation's children and their families.  Similarly, I will remember Norman Anderson as the CEO who succeeded in having our Association named by the national media as a wonderful place to work.  To see these individuals being sharply criticized today for doing their jobs is simply unfair and not right!

            Having worked on the staff of the U.S. Senate for 38+ years, I have come to appreciate the unique (and at times delicate) role that senior staff must play in order to keep an organization functioning smoothly and goal oriented.  Psychology's elected officials (on Council and Boards and Committees) set overall policy.  Within that framework, senior staff work tirelessly to implement mutually agreed upon goals and objectives, often consulting extensively with their committee chairperson.  It is frequently the responsibility of staff to draft correspondence, formal statements such as language for proposed resolutions, and even speeches for the elected ones to cogently present.  One should never forget that staff, no matter how senior or knowledgeable about a given content area, do notvote.  That is solely the responsibility of those elected to office.  If during the process there are any questions about documents presented to the committee, it is the obligation of the elected members to raise questions and respond to the proffered answers.  On the PENS report, for example, I understand that multiple governance groups had the opportunity to respond at different times during the process.

The Hoffman Report was to address the issue of whether APA officials (including staff) "colluded with" the Department of Defense.  The Report stated: "The collusion here was, at the least, to adopt and maintain APA ethics policies that were not more restrictive than the guidelines that key DoD officials wanted, and that were as closely aligned as possible with DoD policies, guidelines, practices, or preferences, as articulated to APA by these DoD officials."  From my perspective, more appropriate terminology might be the less value-drive term "collaborated with."  APA is fundamentally a membership organization and whenever its policies could potentially have a direct impact upon any segment of the membership, the organization has a long history of reaching out to those who might be affected to explore how to most effectively accomplish mutually agreed upon objectives.  For example, during the early discussions surrounding the CHAPUS peer review efforts, the voices of independent practitioners were affirmatively solicited and responded to.  Certainly, in working on the specialty forensic guidelines, staff worked closely with forensic psychologists.  These collaborations seem most reasonable to me.

During my years working for the legislative arm of the federal government, I learned that almost all levels of executive staff within every federal agency were extraordinarily hesitant to be identified as talking with outside entities (such as Congressional staff), especially outside of their formal "chain of command."  This orientation might provide an alternative explanation for the Hoffman Report's finding that many of the APA staff-agency discussions (e-mails or phone) were labeled "confidential."  Perhaps this approach was intended not to keep governance members uninformed; but instead, to provide a level of protection to colleagues working within the federal agencies.  I will not pretend to know the answer; however, I would suggest that there are many possible alternative explanations for the behaviors that were the focus of the Toronto Town Hall meeting.

Personally, I have never heard any of my colleagues or APA staff expressing support for torture and I seriously doubt that I ever will, notwithstanding impressions that may have been conveyed by the media.  This reflects a fundamental personal value system which, growing up as an altar boy in a Russian Orthodox church, I am very proud of.  It seems to me that much of the ongoing discussion has wondered away from the fundamental question of whether APA policy has had the effect of facilitating torture on any detainee and instead addresses other agendas, which although they may be meritorious are, in my judgment, tangential.  For example, some have called for increasing the voice of early career and ethnic minority psychologists within the APA governance.  These are objectives which I would strongly support – and reflect one of the underlying reasons why I have not run for any APA elected office since the end of my Presidential term.  However, I do not feel that this directly addresses the underlying issue of whether APA has acted in a manner which condones torture.  Monitor on Psychology.  Aloha,

Pat DeLeon, former APA President – Division One – September, 2015.."

 

Click on this link to unsubscribe from this list UNSUBSCRIBE

An email will automatically open with "Unsubscribe" in the subject area. Just Send the message, as is, to unsubscribe from this list..

“NEW APA POLICY BANS PSYCHOLOGIST PARTICIPATION ….”

The APA State Leadership Conference (SLC):  One of the highlights of my year has always been the annual Practice Directorate/Practice Organization State Leadership Conference (SLC), where Katherine Nordal exposes approximately 550+ state association leaders from around the country to the changes evolving within the nation's health care system, as well as the world of national politics.  One of her subtle reoccurring themes is the importance of the attendees getting to know their local media on a personal basis, in order to educate them about the field of psychology and our collective potential for having a positive impact upon society's most pressing needs.  Dan Ullman, for example, recently shared with us an article from the Star-Heraldgraphically describing the compelling need for quality mental health care throughout the rural areas of Nebraska.  This will undoubtedly be used by the Nebraska Psychological Association in furtherance of their contemplated RxP legislation.  Earlier this year, I was invited by President Lori Butts to participate in the Florida Psychological Association annual meeting where their ongoing efforts to collaborate with the media were highlighted.  And, I am well aware that the Hawaii Psychological Association hosts an annual media award.  There can be no question that the media has a major impact upon society's appreciation of psychology.  During our Toronto convention, the impact of the New York Times coverage (as well as that of other major news organizations) of the Hoffman Report was quite evident.

            The Hoffman Report:  I have had the extremely good fortune to have been involved in the APA governance for approximately a quarter of a century.  It was a wonderful experience – addressing important agendas; working with fantastic colleagues; and a real chance to "make a difference."  Having been interviewed for the Hoffman Report at the invitation of Past President Nadine Kaslow, I read it carefully several times.  As the Report indicated, the specific question the APA Board of Directors asked the authors to address was: "whether APA officials colluded with DoD, CIA, or other government officials 'to support torture.'"

In my judgment, the discussion regarding the Department of Defense (DoD) psychopharmacology (RxP) training program was very accurate.  "The demonstration project thus served a crucial unlocking function for psychology and APA, since it established the legitimacy of a prescription-training program outside of traditional medical school, thus providing a strong answer to the traditional critique from psychiatrists that the only way to be trained in prescribing psychiatric medication was to graduate from a traditional four-year medical school.  We do not believe that by 2005, APA officials were realistically seeking or expecting anything further from DoD on the topic of prescription privileges.  Nor do we believe that APA officials actually worried that a failure to curry favor with DoD would cause DoD to reverse course on prescription privileges by, for instance, disallowing previously-certified psychologists from continuing to prescribe medication when they treated DoD personnel."

            The convention Town Hall meeting focusing upon the Report, chaired by Nadine and President-Elect Susan McDaniel, was most impressive.  More colleagues passionately participated than I had anticipated and they were definitely engaged.  My sincerest appreciation and congratulations to Steven Reisner and his colleagues Stephen Soldz and Jean Maria Arrigo for their personal commitment to having APA address this important issue.  And yet, as I listened to the audience and reviewed the comments being made on various list-serves, I must conclude that if I had been President in 2015, rather than 2000, there is little question that the same individuals would be demanding my resignation.  That realization fosters an entirely different perspective.

            Over the years, I have served in various capacities within the APA governance.  As an elected (or appointed) member of various boards and committees, including three terms on the APA Board of Directors and President in 2000, I relied heavily upon the good judgment of staff and volunteers.  I worked closely with a number of the individuals mentioned in the Hoffman Report and have the highest respect for them and their professional integrity.  For example, during my Presidential year APA CEO Ray Fowler unfortunately suffered serious health problems and Mike Honaker did an outstanding job in his absence.  Similarly, no one has contributed more to APA's smooth functioning than Judy Strassburger during her 40 years of service.  I will never forget how helpful Rhea Farberman was to then-President Norine Johnson during the chaos surrounding 9/11 and her efforts to address the psychological needs of our nation's children and their families.  Similarly, I will remember Norman Anderson as the CEO who succeeded in having our Association named by the national media as a wonderful place to work.  To see these individuals being sharply criticized today for doing their jobs is simply unfair and not right!

            Having worked on the staff of the U.S. Senate for 38+ years, I have come to appreciate the unique (and at times delicate) role that senior staff must play in order to keep an organization functioning smoothly and goal oriented.  Psychology's elected officials (on Council and Boards and Committees) set overall policy.  Within that framework, senior staff work tirelessly to implement mutually agreed upon goals and objectives, often consulting extensively with their committee chairperson.  It is frequently the responsibility of staff to draft correspondence, formal statements such as language for proposed resolutions, and even speeches for the elected ones to cogently present.  One should never forget that staff, no matter how senior or knowledgeable about a given content area, do notvote.  That is solely the responsibility of those elected to office.  If during the process there are any questions about documents presented to the committee, it is the obligation of the elected members to raise questions and respond to the proffered answers.  On the PENS report, for example, I understand that multiple governance groups had the opportunity to respond at different times during the process.

The Hoffman Report was to address the issue of whether APA officials (including staff) "colluded with" the Department of Defense.  The Report stated: "The collusion here was, at the least, to adopt and maintain APA ethics policies that were not more restrictive than the guidelines that key DoD officials wanted, and that were as closely aligned as possible with DoD policies, guidelines, practices, or preferences, as articulated to APA by these DoD officials."  From my perspective, more appropriate terminology might be the less value-drive term "collaborated with."  APA is fundamentally a membership organization and whenever its policies could potentially have a direct impact upon any segment of the membership, the organization has a long history of reaching out to those who might be affected to explore how to most effectively accomplish mutually agreed upon objectives.  For example, during the early discussions surrounding the CHAPUS peer review efforts, the voices of independent practitioners were affirmatively solicited and responded to.  Certainly, in working on the specialty forensic guidelines, staff worked closely with forensic psychologists.  These collaborations seem most reasonable to me.

During my years working for the legislative arm of the federal government, I learned that almost all levels of executive staff within every federal agency were extraordinarily hesitant to be identified as talking with outside entities (such as Congressional staff), especially outside of their formal "chain of command."  This orientation might provide an alternative explanation for the Hoffman Report's finding that many of the APA staff-agency discussions (e-mails or phone) were labeled "confidential."  Perhaps this approach was intended not to keep governance members uninformed; but instead, to provide a level of protection to colleagues working within the federal agencies.  I will not pretend to know the answer; however, I would suggest that there are many possible alternative explanations for the behaviors that were the focus of the Toronto Town Hall meeting.

Personally, I have never heard any of my colleagues or APA staff expressing support for torture and I seriously doubt that I ever will, notwithstanding impressions that may have been conveyed by the media.  This reflects a fundamental personal value system which, growing up as an altar boy in a Russian Orthodox church, I am very proud of.  It seems to me that much of the ongoing discussion has wondered away from the fundamental question of whether APA policy has had the effect of facilitating torture on any detainee and instead addresses other agendas, which although they may be meritorious are, in my judgment, tangential.  For example, some have called for increasing the voice of early career and ethnic minority psychologists within the APA governance.  These are objectives which I would strongly support – and reflect one of the underlying reasons why I have not run for any APA elected office since the end of my Presidential term.  However, I do not feel that this directly addresses the underlying issue of whether APA has acted in a manner which condones torture.  Monitor on Psychology.  Aloha,

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

Division One Fall column

“NEW APA POLICY BANS PSYCHOLOGIST PARTICIPATION….”

            The APA State Leadership Conference (SLC):  One of the highlights of my year has always been the annual Practice Directorate/Practice Organization State Leadership Conference (SLC), where Katherine Nordal exposes approximately 550+ state association leaders from around the country to the changes evolving within the nation’s health care system, as well as the world of national politics.  One of her subtle reoccurring themes is the importance of the attendees getting to know their local media on a personal basis, in order to educate them about the field of psychology and our collective potential for having a positive impact upon society’s most pressing needs.  Dan Ullman, for example, recently shared with us an article from the Star-Herald graphically describing the compelling need for quality mental health care throughout the rural areas of Nebraska.  This will undoubtedly be used by the Nebraska Psychological Association in furtherance of their contemplated RxP legislation.  Earlier this year, I was invited by President Lori Butts to participate in the Florida Psychological Association annual meeting where their ongoing efforts to collaborate with the media were highlighted.  And, I am well aware that the Hawaii Psychological Association hosts an annual media award.  There can be no question that the media has a major impact upon society’s appreciation of psychology.  During our Toronto convention, the impact of the New York Times coverage (as well as that of other major news organizations) of the Hoffman Report was quite evident.

            The Hoffman Report:  I have had the extremely good fortune to have been involved in the APA governance for approximately a quarter of a century.  It was a wonderful experience – addressing important agendas; working with fantastic colleagues; and a real chance to “make a difference.”  Having been interviewed for the Hoffman Report at the invitation of Past President Nadine Kaslow, I read it carefully several times.  As the Report indicated, the specific question the APA Board of Directors asked the authors to address was: “whether APA officials colluded with DoD, CIA, or other government officials ‘to support torture.’”

In my judgment, the discussion regarding the Department of Defense (DoD) psychopharmacology (RxP) training program was very accurate.  “The demonstration project thus served a crucial unlocking function for psychology and APA, since it established the legitimacy of a prescription-training program outside of traditional medical school, thus providing a strong answer to the traditional critique from psychiatrists that the only way to be trained in prescribing psychiatric medication was to graduate from a traditional four-year medical school.  We do not believe that by 2005, APA officials were realistically seeking or expecting anything further from DoD on the topic of prescription privileges.  Nor do we believe that APA officials actually worried that a failure to curry favor with DoD would cause DoD to reverse course on prescription privileges by, for instance, disallowing previously-certified psychologists from continuing to prescribe medication when they treated DoD personnel.”

            The convention Town Hall meeting focusing upon the Report, chaired by Nadine and President-Elect Susan McDaniel, was most impressive.  More colleagues passionately participated than I had anticipated and they were definitely engaged.  My sincerest appreciation and congratulations to Steven Reisner and his colleagues Stephen Soldz and Jean Maria Arrigo for their personal commitment to having APA address this important issue.  And yet, as I listened to the audience and reviewed the comments being made on various list-serves, I must conclude that if I had been President in 2015, rather than 2000, there is little question that the same individuals would be demanding my resignation.  That realization fosters an entirely different perspective.

            Over the years, I have served in various capacities within the APA governance.  As an elected (or appointed) member of various boards and committees, including three terms on the APA Board of Directors and President in 2000, I relied heavily upon the good judgment of staff and volunteers.  I worked closely with a number of the individuals mentioned in the Hoffman Report and have the highest respect for them and their professional integrity.  For example, during my Presidential year APA CEO Ray Fowler unfortunately suffered serious health problems and Mike Honaker did an outstanding job in his absence.  Similarly, no one has contributed more to APA’s smooth functioning than Judy Strassburger during her 40 years of service.  I will never forget how helpful Rhea Farberman was to then-President Norine Johnson during the chaos surrounding 9/11 and her efforts to address the psychological needs of our nation’s children and their families.  Similarly, I will remember Norman Anderson as the CEO who succeeded in having our Association named by the national media as a wonderful place to work.  To see these individuals being sharply criticized today for doing their jobs is simply unfair and not right!

            Having worked on the staff of the U.S. Senate for 38+ years, I have come to appreciate the unique (and at times delicate) role that senior staff must play in order to keep an organization functioning smoothly and goal oriented.  Psychology’s elected officials (on Council and Boards and Committees) set overall policy.  Within that framework, senior staff work tirelessly to implement mutually agreed upon goals and objectives, often consulting extensively with their committee chairperson.  It is frequently the responsibility of staff to draft correspondence, formal statements such as language for proposed resolutions, and even speeches for the elected ones to cogently present.  One should never forget that staff, no matter how senior or knowledgeable about a given content area, do not vote.  That is solely the responsibility of those elected to office.  If during the process there are any questions about documents presented to the committee, it is the obligation of the elected members to raise questions and respond to the proffered answers.  On the PENS report, for example, I understand that multiple governance groups had the opportunity to respond at different times during the process.

The Hoffman Report was to address the issue of whether APA officials (including staff) “colluded with” the Department of Defense.  The Report stated: “The collusion here was, at the least, to adopt and maintain APA ethics policies that were not more restrictive than the guidelines that key DoD officials wanted, and that were as closely aligned as possible with DoD policies, guidelines, practices, or preferences, as articulated to APA by these DoD officials.”  From my perspective, more appropriate terminology might be the less value-drive term “collaborated with.”  APA is fundamentally a membership organization and whenever its policies could potentially have a direct impact upon any segment of the membership, the organization has a long history of reaching out to those who might be affected to explore how to most effectively accomplish mutually agreed upon objectives.  For example, during the early discussions surrounding the CHAPUS peer review efforts, the voices of independent practitioners were affirmatively solicited and responded to.  Certainly, in working on the specialty forensic guidelines, staff worked closely with forensic psychologists.  These collaborations seem most reasonable to me.

During my years working for the legislative arm of the federal government, I learned that almost all levels of executive staff within every federal agency were extraordinarily hesitant to be identified as talking with outside entities (such as Congressional staff), especially outside of their formal “chain of command.”  This orientation might provide an alternative explanation for the Hoffman Report’s finding that many of the APA staff-agency discussions (e-mails or phone) were labeled “confidential.”  Perhaps this approach was intended not to keep governance members uninformed; but instead, to provide a level of protection to colleagues working within the federal agencies.  I will not pretend to know the answer; however, I would suggest that there are many possible alternative explanations for the behaviors that were the focus of the Toronto Town Hall meeting.

Personally, I have never heard any of my colleagues or APA staff expressing support for torture and I seriously doubt that I ever will, notwithstanding impressions that may have been conveyed by the media.  This reflects a fundamental personal value system which, growing up as an altar boy in a Russian Orthodox church, I am very proud of.  It seems to me that much of the ongoing discussion has wondered away from the fundamental question of whether APA policy has had the effect of facilitating torture on any detainee and instead addresses other agendas, which although they may be meritorious are, in my judgment, tangential.  For example, some have called for increasing the voice of early career and ethnic minority psychologists within the APA governance.  These are objectives which I would strongly support – and reflect one of the underlying reasons why I have not run for any APA elected office since the end of my Presidential term.  However, I do not feel that this directly addresses the underlying issue of whether APA has acted in a manner which condones torture.  Monitor on Psychology.  Aloha,

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