ALOHA - HPA

“THE NIGHT THEY DROVE OLD DIXIE DOWN”

            The Board on Children, Youth, and Families (BCYF) of the National Academies of Science, Engineering, and Medicine recently held its fall meeting, following the election of our nation’s 45th President, Donald J. Trump.  His opponent, Secretary Hillary R. Clinton, has long been an outspoken advocate for children, working early in her career for the Children’s Defense Fund and ultimately serving as chair of its board of directors.  Members of BCYF were clearly “interested” in any indications regarding what the new Administration’s first 100 days might entail.  The President-elect had proposed repealing Obama Care (ACA); but what about the 32+ million Americans who, but for ACA, would not even be receiving necessary primary care?  Hope was expressed that children’s issues would remain truly bipartisan in appeal.

            Under the leadership of Chair Angela Diaz, MD, MPH (former White House Fellow) and Board Director Natacha Blain (former APA Congressional Fellow), BCYF has/will continue its charge to convene top experts from multiple disciplines to analyze the best available evidence on critical issues facing children, youth, and families today.  The underlying approach is to evaluate research simultaneously from the perspectives of the biological, behavioral, health, and social sciences and thereby shed light on innovative and influential solutions in order to inform the nation.  All agree that critical to BCYF’s future will be its continued ability to provide independent analyses of the available science.  Some would suggest that this is especially important at this point in our nation’s history.  Two recent BCYF initiatives:

            Supporting the parents of young children [July, 2016].  A national framework for strengthening the capacity of parents of young children (birth to age 8) was proposed.  Efforts were made to identify a core set of parenting knowledge, attitudes, and practices (KAPs) tied to positive parent-child interactions and child outcomes, as well as evidence-based strategies supporting these KAPs universally, across a variety of specific populations.  Concrete policy recommendations were generated, across private and public sectors, within the health, human services, and education systems, including the most pressing research gaps.  Populations of interest -- fathers, immigrant families, persons with substance abuse and/or mental health issues, low income families, single mother headed households, and parents of children with disabilities.  Contextual areas of interest -- resource poor neighborhoods, unsafe communities, rural communities, availability of quality health care and education systems and services (including early childhood education), and employment opportunities.  The underlying vision is to serve as a “roadmap” for the future of parenting and family support policies, practices, and research.

            The biological and psychosocial effects of Peer Victimization: Lessons for bullying prevention [May, 2016].  Three key questions were addressed:  * What is known about the physiological and psychosocial consequences of peer victimization for both the perpetrator and target?  Specifically, what is the state of research on the neurobiological and mental and behavioral health effects of peer victimization?  * How are individual and other characteristics (e.g., cognitive and social skills and affective dispositions) related to the dynamic between perpetrator and target, and the subsequent initial signs and long-term outcomes for both?  And, * What factors contribute to resilient outcomes of youth exposed to, and engaged in, peer victimization (e.g., safe and supportive school climate; relationships with adults and peers)?  Key findings: * Bullying is associated with harmful short- and long-term consequences both for youths who are bullied and for those who do the bullying.  Individuals who are both perpetrators and targets for bullying appear to be at greatest risk for poor psychological and social outcomes.  And, * Emerging research indicates that some widely-used approaches, such as zero-tolerance policies, are not effective at reducing bullying.

Give an Hour:  The increasing integration of mental/behavioral health into primary care has provided mental health professionals unprecedented opportunities to make a difference in the lives of our nation’s citizens through venues which have heretofore been unrecognized.  In September, 2005 psychologist Barbara Van Dahlen established Give an Hour, with the mission of harnessing the expertise and generosity of volunteer mental health professionals capable of responding to both acute and chronic conditions that arise within our society.  To date, Give an Hour has provided over 210,000 hours of free mental health care (valued at over $21 million) to our nation’s active duty personnel, Veterans, and their families.  The VA reports that every day 20 Veterans commit suicide; however, the Campaign to Change Direction recognizes that the need for mental health care is not limited to our Veterans or to any particular subset of our population, and instead requires a fundamental change in the culture of mental health so that all in need receive the care and support they deserve.  The five signs of emotional suffering are changes in personality, agitation, withdrawal, decline in personal care, and hopelessness.

This fall Barbara invited students from the USUHS to attend a special Sirius XM radio broadcast “Changing the Culture of Mental Health: It’s Time” featuring, among others, Brian Duffy (VFW Commander-in-chief) and Dr. Jill Biden, addressing the importance of eliminating the historical stigma associated with receiving mental health care.  Given her son’s history, Dr. Biden was personally most appreciative of the services rendered by the National Guard and highly sensitive to the stresses which they might experience.  Later on that afternoon, she presided over a Pentagon ceremony during which Give an Hour and the National Guard signed an historic Memorandum of Understanding (MOU) to work closely together.

“As one of the military students in the audience of Jennifer Hammond’s broadcast and as one of the many future health care professionals working to combat suicide, I greatly appreciated the opportunity to meet with individuals from different professions to discuss this important topic.  Until recently, suicide was viewed as a cowardly act and in some states, even a crime.  Talking about suicide or suicidal thoughts and how they affect everyday people in different ways is instrumental for changing the culture.  As noted during the broadcast, most individuals know the signs of a heart attack and the basics of what to do.  Through normalizing the experience of mental health strain and thinking critically about what we can do to help ourselves and others, we can inspire change such that mental stress is as easily recognizable as outwardly physical ailments.  Among suicide researchers, an important change is how we speak about those who are afflicted.  The term ‘commit’ is defined as ‘to carry out; to perpetrate.’  It brings with it the connotation of the past, that those who experience these thoughts and feelings are somehow committing a crime.  Changing the language, such that those who ‘commit’ suicide are now those that ‘die by suicide’ (akin to ‘died of a heart attack’) changes how we automatically characterize the people we aim to help.  Little changes like these, Give an Hour’s many collective therapy hours, and the support of recognized names such as Dr. Biden and Yashi Brown are what will create lasting cultural change.  I am honored to be a part of it” [Hannah Martinez, 2LT, USA; psychology graduate student].

Dr. Jill Biden: “The Biden family is a National Guard family.  So, it’s incredibly special that my last event at the Pentagon as Second Lady is to witness this National Guard milestone.  Eight years ago, our son Beau proudly deployed for a year to Iraq with the Delaware Army National Guard 261^st Signal Brigade….  When Beau returned home – knowing that Mrs. Obama and I had begun to plan the work eventually known as Joining Forces – he asked that we especially focus on de-stigmatizing and addressing the wounds that could not be seen: such as PTSD and TBI.  The length of those wars and multiple deployments had naturally taken its toll.  And we needed to address the mental wellbeing of our military upfront with dignity and respect….

“Today, we have another incredible organization, answering the call in their own way.  From the bottom of my heart, I want to thank Barbara and everyone at Give an Hour for your strength, determination and foresight.  I always tell people: go to your strengths and Barbara, you have done just that.  You leveraged what you knew into an incredible organization of thousands of mental health providers willing to donate their time to help our troops, Veterans and families.  Thank you….  With this MOU, we will reach countless guard members across this country with the 5 Signs.  We will be able to offer expanded mental health services to our guard members and families through a network of more than 7,000 Give an Hour providers….  As a proud National Guard mom, this is personal…  Thank you, and God bless our troops and their families.”

Exciting Opportunities for Change:  The New Hampshire Psychological Association recently joined with Give an Hour to serve their state’s Veterans and other underserved high risk populations.  This would seem to be a particularly appropriate initiative for HPA, given the significant number of members of the Hawaii National Guard who have been deployed during the past decade.  Kathy McNamara recently had the opportunity to visit with U.S. Senator Mazie Hirono, a member of the Senate Armed Services Committee, who proudly mentioned that her undergraduate major was psychology, so her personal interest in psychological services has been long-standing.   “And all the bells were ringin’.”  Aloha.

Pat DeLeon, former APA President – HPA – December, 2016

 

THE NIGHT THEY DROVE OLD DIXIE DOWN

 The Board on Children, Youth, and Families (BCYF) of the National Academies of Science, Engineering, and Medicine recently held its fall meeting, following the election of our nation's 45th President, Donald J. Trump.  His opponent, Secretary Hillary R. Clinton, has long been an outspoken advocate for children, working early in her career for the Children's Defense Fund and ultimately serving as chair of its board of directors.  Members of BCYF were clearly "interested" in any indications regarding what the new Administration's first 100 days might entail.  The President-elect had proposed repealing Obama Care (ACA); but what about the 32+ million Americans who, but for ACA, would not even be receiving necessary primary care?  Hope was expressed that children's issues would remain truly bipartisan in appeal.

            Under the leadership of Chair Angela Diaz, MD, MPH (former White House Fellow) and Board Director Natacha Blain (former APA Congressional Fellow), BCYF has/will continue its charge to convene top experts from multiple disciplines to analyze the best available evidence on critical issues facing children, youth, and families today.  The underlying approach is to evaluate research simultaneously from the perspectives of the biological, behavioral, health, and social sciences and thereby shed light on innovative and influential solutions in order to inform the nation.  All agree that critical to BCYF's future will be its continued ability to provide independent analyses of the available science.  Some would suggest that this is especially important at this point in our nation's history.  Two recent BCYF initiatives:

            Supporting the parents of young children [July, 2016].  A national framework for strengthening the capacity of parents of young children (birth to age 8) was proposed.  Efforts were made to identify a core set of parenting knowledge, attitudes, and practices (KAPs) tied to positive parent-child interactions and child outcomes, as well as evidence-based strategies supporting these KAPs universally, across a variety of specific populations.  Concrete policy recommendations were generated, across private and public sectors, within the health, human services, and education systems, including the most pressing research gaps.  Populations of interest -- fathers, immigrant families, persons with substance abuse and/or mental health issues, low income families, single mother headed households, and parents of children with disabilities.  Contextual areas of interest -- resource poor neighborhoods, unsafe communities, rural communities, availability of quality health care and education systems and services (including early childhood education), and employment opportunities.  The underlying vision is to serve as a "roadmap" for the future of parenting and family support policies, practices, and research.

            The biological and psychosocial effects of Peer Victimization: Lessons for bullying prevention [May, 2016].  Three key questions were addressed:  * What is known about the physiological and psychosocial consequences of peer victimization for both the perpetrator and target?  Specifically, what is the state of research on the neurobiological and mental and behavioral health effects of peer victimization?  * How are individual and other characteristics (e.g., cognitive and social skills and affective dispositions) related to the dynamic between perpetrator and target, and the subsequent initial signs and long-term outcomes for both?  And, * What factors contribute to resilient outcomes of youth exposed to, and engaged in, peer victimization (e.g., safe and supportive school climate; relationships with adults and peers)?  Key findings: * Bullying is associated with harmful short- and long-term consequences both for youths who are bullied and for those who do the bullying.  Individuals who are both perpetrators and targets for bullying appear to be at greatest risk for poor psychological and social outcomes.  And, * Emerging research indicates that some widely-used approaches, such as zero-tolerance policies, are not effective at reducing bullying.

Give an Hour:  The increasing integration of mental/behavioral health into primary care has provided mental health professionals unprecedented opportunities to make a difference in the lives of our nation's citizens through venues which have heretofore been unrecognized.  In September, 2005 psychologist Barbara Van Dahlen established Give an Hour, with the mission of harnessing the expertise and generosity of volunteer mental health professionals capable of responding to both acute and chronic conditions that arise within our society.  To date, Give an Hour has provided over 210,000 hours of free mental health care (valued at over $21 million) to our nation's active duty personnel, Veterans, and their families.  The VA reports that every day 20 Veterans commit suicide; however, the Campaign to Change Direction recognizes that the need for mental health care is not limited to our Veterans or to any particular subset of our population, and instead requires a fundamental change in the culture of mental health so that all in need receive the care and support they deserve.  The five signs of emotional suffering are changes in personality, agitation, withdrawal, decline in personal care, and hopelessness.

This fall Barbara invited students from the USUHS to attend a special Sirius XM radio broadcast "Changing the Culture of Mental Health: It's Time" featuring, among others, Brian Duffy (VFW Commander-in-chief) and Dr. Jill Biden, addressing the importance of eliminating the historical stigma associated with receiving mental health care.  Given her son's history, Dr. Biden was personally most appreciative of the services rendered by the National Guard and highly sensitive to the stresses which they might experience.  Later on that afternoon, she presided over a Pentagon ceremony during which Give an Hour and the National Guard signed an historic Memorandum of Understanding (MOU) to work closely together.

"As one of the military students in the audience of Jennifer Hammond's broadcast and as one of the many future health care professionals working to combat suicide, I greatly appreciated the opportunity to meet with individuals from different professions to discuss this important topic.  Until recently, suicide was viewed as a cowardly act and in some states, even a crime.  Talking about suicide or suicidal thoughts and how they affect everyday people in different ways is instrumental for changing the culture.  As noted during the broadcast, most individuals know the signs of a heart attack and the basics of what to do.  Through normalizing the experience of mental health strain and thinking critically about what we can do to help ourselves and others, we can inspire change such that mental stress is as easily recognizable as outwardly physical ailments.  Among suicide researchers, an important change is how we speak about those who are afflicted.  The term 'commit' is defined as 'to carry out; to perpetrate.'  It brings with it the connotation of the past, that those who experience these thoughts and feelings are somehow committing a crime.  Changing the language, such that those who 'commit' suicide are now those that 'die by suicide' (akin to 'died of a heart attack') changes how we automatically characterize the people we aim to help.  Little changes like these, Give an Hour's many collective therapy hours, and the support of recognized names such as Dr. Biden and Yashi Brown are what will create lasting cultural change.  I am honored to be a part of it" [Hannah Martinez, 2LT, USA; psychology graduate student].

Dr. Jill Biden: "The Biden family is a National Guard family.  So, it's incredibly special that my last event at the Pentagon as Second Lady is to witness this National Guard milestone.  Eight years ago, our son Beau proudly deployed for a year to Iraq with the Delaware Army National Guard 261^st Signal Brigade….  When Beau returned home – knowing that Mrs. Obama and I had begun to plan the work eventually known as Joining Forces – he asked that we especially focus on de-stigmatizing and addressing the wounds that could not be seen: such as PTSD and TBI.  The length of those wars and multiple deployments had naturally taken its toll.  And we needed to address the mental wellbeing of our military upfront with dignity and respect….

"Today, we have another incredible organization, answering the call in their own way.  From the bottom of my heart, I want to thank Barbara and everyone at Give an Hour for your strength, determination and foresight.  I always tell people: go to your strengths and Barbara, you have done just that.  You leveraged what you knew into an incredible organization of thousands of mental health providers willing to donate their time to help our troops, Veterans and families.  Thank you….  With this MOU, we will reach countless guard members across this country with the 5 Signs.  We will be able to offer expanded mental health services to our guard members and families through a network of more than 7,000 Give an Hour providers….  As a proud National Guard mom, this is personal…  Thank you, and God bless our troops and their families."

Exciting Opportunities for Change:  The New Hampshire Psychological Association recently joined with Give an Hour to serve their state's Veterans and other underserved high risk populations.  This would seem to be a particularly appropriate initiative for HPA, given the significant number of members of the Hawaii National Guard who have been deployed during the past decade.  Kathy McNamara recently had the opportunity to visit with U.S. Senator Mazie Hirono, a member of the Senate Armed Services Committee, who proudly mentioned that her undergraduate major was psychology, so her personal interest in psychological services has been long-standing.   "And all the bells were ringin'."  Aloha.

Pat DeLeon, former APA President – HPA – December, 2016

 

Sent from my iPhone

ALOHA

“WITH ONE FOOT ON THE PLATFORM AND THE OTHER FOOT ON THE TRAIN”

            OUR Nation’s 45th President – “Interesting Times” for Sure:  Those who attended this spring’s APA Practice Organization’s State Leadership Conference should not be surprised with the ultimate outcome.  Political analyst Mark Shields provided an insightful historical perspective.  The last time a Democrat succeeded a two-term member of his/her own party in the White House was 1836, when Martin Van Buren was elected to succeed Andrew Jackson.  2016 is the fourth time in our nation’s history that the President-elect lost the popular vote.  President Donald J. Trump will be our oldest first-term President.  Throughout his campaign and continuing after his election, he has called for repealing Obamacare (ACA).  During the first 100 days of his Administration, he has proposed to fight for the passage of: “Repeal and Replace Obamacare Act.  Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds.”

One can wonder about the fate of those 32+ million Americans who but for the enactment of the ACA would not be receiving primary care with its emphasis upon 10 essential health benefits; which include rehabilitative, preventive, wellness, and chronic disease management services.  Everyone seems to appreciate the elimination of the “preexisting condition” barrier; although many practitioners are having trouble with the evolution towards population-based (with its emphasis upon health disparities), value/evidence-based, care in contrast to our historical volume-based care.  Will the Republican controlled Congress ultimately enact such far-reaching legislation?  Political observers have seen the U.S. Senate slowly, but steadily, watering down the inherent protections of its historical filibuster authority, instead moving towards the “nuclear option” when short-term frustrations have overridden historical perspectives.  Given the economic projections involved, perhaps, as the Uniformed Services University of the Health Sciences (USUHS) medical historian has suggested, our nation is actually moving towards the Single Payer system proposed by Presidential candidate Bernie Sanders?  We shall soon see the results of President Trump’s First 100 Days.

            Continuing Steps for Ensuring Quality “Health Care” by Engaged Colleagues:  “I’m excited to share our work leading Hawaii’s first Medical-Legal Partnership for Children (MLP) program – a collaborative project between the University of Hawaii Law School and Medical School, and two community health centers (Kokua Kalihi Valley and Waimanalo Health Center).  As the only law and medical schools in the State of Hawaii, this collaboration provides significant interdisciplinary training opportunities for the next generation of Hawaii’s professionals.  We follow three core activities (as established by the National Center for Medical-Legal Partnerships):  1. Providing free, direct legal services for low income families, on-site at a community health center.  2. Training health professionals about the underlying legal needs of low-income patients.  And,  3. Engaging together to address systemic advocacy, including policy matters and community empowerment.

            “Briefly, our work helps low-income patient-families in areas of housing (preventing evictions, winning credits for public housing residents wrongly overcharged, ensuring disability access, etc.), strengthening families through family law (guardianships, powers of attorney, child support, and domestic violence advocacy), filing discrimination complaints in employment and housing, and preserving much-needed public benefits for our most vulnerable children.  In addition, we are dedicated to community education and empowerment, focusing on ‘know your rights’ training and self-advocacy skills, especially for immigrant families in Hawaii.  This work has led low-income participants to successfully assert their rights in housing, healthcare (especially around language access), education, and other areas.  We have also increased our clients’ capacity to participate in civic engagement and policy matters; much of our work has been focused on access to healthcare for Micronesian migrants in Hawaii.

            “As a project of the University of Hawaii, we have strong relationships with other university programs, including public health, public administration, social work, nursing, and education.  This is especially important as we seek support to better evaluate our impact, especially looking beyond quantitative measures to include qualitative measures and our impact in addressing the social-determinants of health.  Those interdisciplinary connections are so crucial to better health and wellness [Dina Shek].”

            Give an Hour:  Barbara Van Dahlen, Founder & President of Give an Hour, is constantly striving to Change the Direction of how our nation views mental health.  Given the historical stigma, her efforts are critical for integrated holistic/behavioral health care for all Americans.  Give an Hour has provided over 200,000 hours of free mental health care (valued at over $20 million) to our nation’s active duty personnel, Veterans, and their families.  This year Barbara has particularly focused upon the role of motion pictures in shaping our nation’s attitudes and expectations (i.e., our culture).  In the fall, she arranged for Wendy Anderson, executive producer, and psychologist Jerry Sullivan to participate in a panel discussion and screening of “Citizen Soldier” at USUHS.  The film provides a dramatic look at the realities of combat from the point of view of a group of Soldiers in the Oklahoma Army National Guard’s 45^th Infantry Brigade Combat Team, known since WWII as the “Thunderbirds,” who were deployed to one of the most dangerous parts of Afghanistan at the height of the surge.

            “USUHS students Michelle Binder and Annie Barajas (both USAF Captains and Psychiatric Nurse Practitioner DNP students) attended the screening and found the film to be a valuable tool for mental health providers as well as patients’ families.  While speaking with the executive producer after reviewing the film, they promised that they will ensure that every mental health provider in their future clinics would watch the film.  ‘This film will save families… I’m sure it has already saved lives.’  Both students felt the movie conveyed the story of soldiers’ wartime experiences in a palpable way – riveting viewers while also eliciting empathy and a brief glimpse into what these citizen soldiers go through before, during, and after war.  ‘I’ve been deployed, but I haven’t seen direct combat.  I understand how it feels to come home and feel detached and isolated, but this film gives me a much clearer perspective on the combat experience and the importance of unit cohesion.’  ‘We both feel that the Campaign to Change Direction’s initiative, using film to change the narrative about mental health, will make a huge impact – especially on this young generation of military service members.’”  The film used real footage from multiple cameras, including helmet cams, providing an intimate view into the chaos and horrors of combat and, in the process, displayed the bravery and valor of the Thunderbirds under the most hellish of conditions.  Nineteen Oklahoma National Guard troops lost their lives in Iraq and Afghanistan between 9/11 and March, 2016.

            Critical to the successes of Dina’s Medical-Legal Partnership, Wendy Anderson’s intimately moving documentary, and Give an Hour is their consistent appreciation for the importance of community engagement and empowerment.  Without the time and effort invested in building relationships and trust with those most impacted, these important initiatives would not have been possible.  This is a fundamental approach to addressing society’s most pressing needs that is often overlooked by those who perceive themselves as being “in power” and/or possessing special skills, whether they are clinical or intellectual/artistic.

           Given the importance of APA’s State Associations to all of psychology, we were very pleased to learn that Give an Hour has now developed their first major State Association collaborative partnership with our colleagues in New Hampshire.  They will be engaging psychologists to “Join Give an Hour to Change Direction.”  Practitioners from the Granite State will donate their hour a week to provide care, consultation, expertise – across a number of areas – to service members and Veterans – and to other at risk groups in their state.  Barbara is proud to be partnering with the New Hampshire Psychological Association on this critical effort and encourages other associations to join Give an Hour and the Change Direction initiative.  As she notes, “Psychologists have unique skills and abilities that are sorely needed in communities across the country.  We encourage every State Association to join us as we Change the Culture of mental health by increasing access to care and by educating all Americans to recognize the signs of emotional suffering.  Providing care to those in need enriches the lives of those who give as well as those who receive and elevates the value of our profession.”

Currently there are more than 19 million Veterans living in the United States.  The largest cohort (6.2 million) represents Vietnam Veterans 270,000 of whom are diagnosed with PTSD; one-third also exhibit co-morbid depression and anxiety.  The VA reports that every day 20 Veterans commit suicide, over 65% are over the age of 50, disproportionately representing those who served during Vietnam.  APA does not have an Office of Veterans Affairs.  Why not?  Has your Division and/or State Association leadership spoken out on this issue?  “A house in New Orleans they call the rising sun.”  Aloha,

Pat DeLeon, former APA President – Division 42 -- November, 2016

 

 

WITH ONE FOOT ON THE PLATFORM AND THE OTHER FOOT ON THE TRAIN

OUR Nation's 45th President – "Interesting Times" for Sure:  Those who attended this spring's APA Practice Organization's State Leadership Conference should not be surprised with the ultimate outcome.  Political analyst Mark Shields provided an insightful historical perspective.  The last time a Democrat succeeded a two-term member of his/her own party in the White House was 1836, when Martin Van Buren was elected to succeed Andrew Jackson.  2016 is the fourth time in our nation's history that the President-elect lost the popular vote.  President Donald J. Trump will be our oldest first-term President.  Throughout his campaign and continuing after his election, he has called for repealing Obamacare (ACA).  During the first 100 days of his Administration, he has proposed to fight for the passage of: "Repeal and Replace Obamacare Act.  Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds."

One can wonder about the fate of those 32+ million Americans who but for the enactment of the ACA would not be receiving primary care with its emphasis upon 10 essential health benefits; which include rehabilitative, preventive, wellness, and chronic disease management services.  Everyone seems to appreciate the elimination of the "preexisting condition" barrier; although many practitioners are having trouble with the evolution towards population-based (with its emphasis upon health disparities), value/evidence-based, care in contrast to our historical volume-based care.  Will the Republican controlled Congress ultimately enact such far-reaching legislation?  Political observers have seen the U.S. Senate slowly, but steadily, watering down the inherent protections of its historical filibuster authority, instead moving towards the "nuclear option" when short-term frustrations have overridden historical perspectives.  Given the economic projections involved, perhaps, as the Uniformed Services University of the Health Sciences (USUHS) medical historian has suggested, our nation is actually moving towards the Single Payer system proposed by Presidential candidate Bernie Sanders?  We shall soon see the results of President Trump's First 100 Days.

            Continuing Steps for Ensuring Quality "Health Care" by Engaged Colleagues:  "I'm excited to share our work leading Hawaii's first Medical-Legal Partnership for Children (MLP) program – a collaborative project between the University of Hawaii Law School and Medical School, and two community health centers (Kokua Kalihi Valley and Waimanalo Health Center).  As the only law and medical schools in the State of Hawaii, this collaboration provides significant interdisciplinary training opportunities for the next generation of Hawaii's professionals.  We follow three core activities (as established by the National Center for Medical-Legal Partnerships):  1. Providing free, direct legal services for low income families, on-site at a community health center.  2. Training health professionals about the underlying legal needs of low-income patients.  And,  3. Engaging together to address systemic advocacy, including policy matters and community empowerment.

            "Briefly, our work helps low-income patient-families in areas of housing (preventing evictions, winning credits for public housing residents wrongly overcharged, ensuring disability access, etc.), strengthening families through family law (guardianships, powers of attorney, child support, and domestic violence advocacy), filing discrimination complaints in employment and housing, and preserving much-needed public benefits for our most vulnerable children.  In addition, we are dedicated to community education and empowerment, focusing on 'know your rights' training and self-advocacy skills, especially for immigrant families in Hawaii.  This work has led low-income participants to successfully assert their rights in housing, healthcare (especially around language access), education, and other areas.  We have also increased our clients' capacity to participate in civic engagement and policy matters; much of our work has been focused on access to healthcare for Micronesian migrants in Hawaii.

            "As a project of the University of Hawaii, we have strong relationships with other university programs, including public health, public administration, social work, nursing, and education.  This is especially important as we seek support to better evaluate our impact, especially looking beyond quantitative measures to include qualitative measures and our impact in addressing the social-determinants of health.  Those interdisciplinary connections are so crucial to better health and wellness [Dina Shek]."

            Give an Hour:  Barbara Van Dahlen, Founder & President of Give an Hour, is constantly striving to Change the Direction of how our nation views mental health.  Given the historical stigma, her efforts are critical for integrated holistic/behavioral health care for all Americans.  Give an Hour has provided over 200,000 hours of free mental health care (valued at over $20 million) to our nation's active duty personnel, Veterans, and their families.  This year Barbara has particularly focused upon the role of motion pictures in shaping our nation's attitudes and expectations (i.e., our culture).  In the fall, she arranged for Wendy Anderson, executive producer, and psychologist Jerry Sullivan to participate in a panel discussion and screening of "Citizen Soldier" at USUHS.  The film provides a dramatic look at the realities of combat from the point of view of a group of Soldiers in the Oklahoma Army National Guard's 45^th Infantry Brigade Combat Team, known since WWII as the "Thunderbirds," who were deployed to one of the most dangerous parts of Afghanistan at the height of the surge.

            "USUHS students Michelle Binder and Annie Barajas (both USAF Captains and Psychiatric Nurse Practitioner DNP students) attended the screening and found the film to be a valuable tool for mental health providers as well as patients' families.  While speaking with the executive producer after reviewing the film, they promised that they will ensure that every mental health provider in their future clinics would watch the film.  'This film will save families… I'm sure it has already saved lives.'  Both students felt the movie conveyed the story of soldiers' wartime experiences in a palpable way – riveting viewers while also eliciting empathy and a brief glimpse into what these citizen soldiers go through before, during, and after war.  'I've been deployed, but I haven't seen direct combat.  I understand how it feels to come home and feel detached and isolated, but this film gives me a much clearer perspective on the combat experience and the importance of unit cohesion.'  'We both feel that the Campaign to Change Direction's initiative, using film to change the narrative about mental health, will make a huge impact – especially on this young generation of military service members.'"  The film used real footage from multiple cameras, including helmet cams, providing an intimate view into the chaos and horrors of combat and, in the process, displayed the bravery and valor of the Thunderbirds under the most hellish of conditions.  Nineteen Oklahoma National Guard troops lost their lives in Iraq and Afghanistan between 9/11 and March, 2016.

            Critical to the successes of Dina's Medical-Legal Partnership, Wendy Anderson's intimately moving documentary, and Give an Hour is their consistent appreciation for the importance of community engagement and empowerment.  Without the time and effort invested in building relationships and trust with those most impacted, these important initiatives would not have been possible.  This is a fundamental approach to addressing society's most pressing needs that is often overlooked by those who perceive themselves as being "in power" and/or possessing special skills, whether they are clinical or intellectual/artistic.

           Given the importance of APA's State Associations to all of psychology, we were very pleased to learn that Give an Hour has now developed their first major State Association collaborative partnership with our colleagues in New Hampshire.  They will be engaging psychologists to "Join Give an Hour to Change Direction."  Practitioners from the Granite State will donate their hour a week to provide care, consultation, expertise – across a number of areas – to service members and Veterans – and to other at risk groups in their state.  Barbara is proud to be partnering with the New Hampshire Psychological Association on this critical effort and encourages other associations to join Give an Hour and the Change Direction initiative.  As she notes, "Psychologists have unique skills and abilities that are sorely needed in communities across the country.  We encourage every State Association to join us as we Change the Culture of mental health by increasing access to care and by educating all Americans to recognize the signs of emotional suffering.  Providing care to those in need enriches the lives of those who give as well as those who receive and elevates the value of our profession."

Currently there are more than 19 million Veterans living in the United States.  The largest cohort (6.2 million) represents Vietnam Veterans 270,000 of whom are diagnosed with PTSD; one-third also exhibit co-morbid depression and anxiety.  The VA reports that every day 20 Veterans commit suicide, over 65% are over the age of 50, disproportionately representing those who served during Vietnam.  APA does not have an Office of Veterans Affairs.  Why not?  Has your Division and/or State Association leadership spoken out on this issue?  "A house in New Orleans they call the rising sun."  Aloha,

Pat DeLeon, former APA President – Division 42 -- November, 2016

 

 

Sent from my iPhone

ALOHA - Division 29 column

“WHY DON’T YOU LET ME GO HOME”

            The Importance of Pursuing One’s Passion:  It is exciting to reflect upon the challenges which dedicated colleagues have willingly embraced, especially when they are serving the “public good.”  Two of our true RxP pioneers, who from the beginning have been on the front-line treating those in need of appropriate psychopharmacological care, have recently joined forces to promote global mental health.  New Mexico’s Elaine LeVine and USAF (Ret.) Elaine Foster, who are among our earliest prescribing psychologists, have partnered to take on a weighty challenge indeed – global mental health.  According to the World Health Organization (WHO), half of all countries in the world have less than one psychiatrist per 100,000 people, and a third of all countries have no mental health programs at all.  Access and quality of care are extremely critical within the U.S. and are even more striking in middle- and low-income countries.  Our colleagues are well known for taking an unconventional slant on traditional medicine through their Psychobiosocial Model of Care.  They emphasize psychological factors in all aspects of evaluation and treatment; the more traditional medical school “biopsychosocial” model typically emphasizes body over mind (the physical over the psyche).

            WHO outlines the evolution of integrated care for mental health providers through a concept called “task shifting.”  This is a process of expanded training for the healthcare workforce.  The goal is to empower health workers to better assist those in need.  In many countries there are few medical practitioners and the populations they serve are so vast that they are often not able to provide day-by-day services to their patients.  Task shifting allows a mental health worker to make recommendations to a primary care doctor regarding treatment options, based on augmented training in psychopharmacology from a psychobiosocial perspective.

            Our dedicated colleagues have moved beyond the theoretical concept of task shifting by launching a nonprofit organization, RxP International.  The organization’s mission is to provide training in psychiatric medications as an adjunct to the many types of therapies that can be used in place of medicine.  In order to make rational recommendations about when medications should be avoided or discontinued, a mental health provider must understand when, how, and why they are used in the first place.  Helping practitioners gain the information and skills of this psychobiosocial model so that they consult effectively with medical personnel who are prescribing psychotropics is clearly a social justice concern since the focus is teaching people to better help themselves.

            In order to reach the broadest population, RxP international has designed courses that can be offered through distance learning and an open communication forum.  The courses target the most commonly diagnosed conditions, such as anxiety, depression, and psychosis, along with special populations, such as the elderly and children.  The online forum is actively managed to help student-providers share their unique experiences and needs from their place in the world.  In addition to providing a more personalized educational experience, the information from this forum will be used by the course developers to gain a better understanding of mental health needs and interests around the globe.  The RxP International signature course is a one-hour presentation on social justice, explaining the philosophy behind the movement and case studies on the New Mexico-Mexico border.

            In many ways, this vision is targeting the need of those front-line practitioners who are addressing society’s real needs (i. e., those within the VA, DoD, state mental health systems, and federally qualified community health centers (FQHCs)).  The underlying goal is to provide readily available quality psychopharmacological expertise for dedicated public servants who need access to practical information, regardless of whether or not they receive a formal credential.   “We want to create a dynamic learning environment where anyone, regardless of their formal professional discipline, who wants to expand their clinical skills anywhere in the world can join this social justice movement” [Elaine Foster].  Current faculty include: Elaine Foster, Elaine LeVine, Mark Muse; Mitchell Simson, MD; and John Preston.  RxP International will be enlarging their number of offerings as the curriculum undergoes future iterations.  Their website – www.rxpint.org.

            One of psychology’s first RxP training programs was developed by former Division 55 (American Society for the Advancement of Pharmacotherapy) President Bob McGrath at Fairleigh Dickinson University.  Bob is currently the university’s Director of Integrated Care for the Underserved of Northeastern New Jersey – pursuing his passion for furthering psychology’s involvement in serving those “most-in-need” by working closely with FQHCs.  With the recent legislative success in Iowa, I asked what was their enrollment.  Anne Farrar-Anton, the new director, responded from 38-45 new students each year, which is quite impressive.  Recall that in Denver, Bethe Lonning pointed out that although it did take Iowa a decade to enact RxP legislation, since 2011 they had only needed to raise $3,535.50.  The key to their success was grassroots campaigning and believing that their agenda was important for the citizens of Iowa.  Accordingly, we would suggest that as the number of practicing psychologists obtaining this specialized training continues to increase and as the media continues to focus upon the pressing needs for quality mental health care (the VA reports that every day 20 Veterans commit suicide) more and more states will achieve legislative success.

            A Fascinating Training Opportunity:  “The Military Contingency Medicine (MCM) course, which includes the field training exercise called ‘Bushmaster’, epitomizes the mission of USUHS: preparing health care providers to operate in any environment around the world.  There are two phases to the exercise and each phase is important.  The first phase is a two-week didactic experience that ranges from dental emergencies in the field to the United States strategic goals of Global Health Engagement.  The practical knowledge imparted is important, but what will last personally is an epiphany moment of recognizing ‘Military Health’ as its own unique specialty, a conceptualization of both the population I will treat and the role I will fulfill.  The second phase of MCM is Bushmaster, which lasts six days at a military installation in Pennsylvania.  I participated by providing mental health expertise and support to the main body of troops training.  It was an impressive operation and some of the highest-quality training in my military career.  More than that, it had the unbeatable quality inherent to much of military life, camaraderie and fun of being part of a large group of people with a shared goal.  However, the truly lasting effect of Bushmaster will be the exchange of ideas and the relationships built between our graduate nursing students, international participants, medical students, faculty, USUHS alumni, and practicing providers from across the country.  People I am guaranteed to cross paths with again, both stateside and across the world on any given mission” [Doug Taylor, USUHS mental health DNP student].

            Evolving Approaches to the Future:  With the enactment of President Obama’s Patient Protection and Affordable Care Act (ACA), the delivery of health care services within our nation is steadily evolving towards integrated systems of care, rather than maintaining our historical reliance on independent practice models.  The federal government, and particularly the Departments of Defense (DoD) and Veterans Affairs (VA), have been on the cutting-edge of this movement.  This was evident at the town hall meeting hosted last year by then-FPA President Lori Butts during the Florida Psychological Association’s 2015 Annual Convention, as her VA colleagues described their ongoing successes and challenges in meeting the mental health needs of their beneficiaries utilizing the maturing VA telehealth capabilities.

Licensure mobility is one of the new challenges facing practitioners of all disciplines who are interested in providing care in the 21^st Century.  Why should the locus of where one practices – especially in today’s virtual lifespace – continue to be a determining factor of one’s scope of practice?  In October, 1998 the Pew Health Professions Commission, chaired by the former Senate Majority Leader George Mitchell, recommended: “Congress should establish a national policy advisory body that will research, develop and publish national scopes of practice and continuing competency standards for state legislatures to implement.”  This summer the VA proposed to permit full practice authority for its Advanced Practice Registered Nurses (APRNs) relying upon its federal supremacy authority.  By the close of the public commentary period, an extraordinary 223,000 comments had been received approximately 60% supportive.  Under the leadership of APA immediate Past-President Barry Anton and President-Elect Tony Puente, 16 former APA Presidents submitted a letter in support of the VA’s proposal.  The APA Practice Organization signed on to a similar statement as a member of the Coalition for Patients’ Rights, along with the American Physical Therapy Association.  The American Association of Colleges of Pharmacy and the Federal Trade Commission also submitted highly supportive comments.  It is significant that this proposal would only impact federal nurses working within VA facilities.

From a public policy perspective, the issue of licensure mobility becomes significantly more complex when one contemplates providing federal reimbursement to private sector clinicians for serving the health care needs of federal beneficiaries via telehealth.  The Senate Fiscal Year 2017 National Defense Authorization Act (S. 2943) would authorize the military’s TRICARE program to reimburse for telehealth, including mobile health applications.  One aspect of this proposed authority, however, provides that for purposes of reimbursement, licensure, and professional liability relating to the provision of telehealth services, providers shall be considered to be furnishing such services at their location and not at the location of the patient.  In response, the AMA and the American Association of Family Physicians (AAFP) expressed the concern that this approach would essentially create a workaround to medical licensure and lead to physicians who aren’t accountable to any medical board, since the board in the patient’s state would not be able to regulate an out-of-state physician and the board in the physician’s home state could not regulate an interaction with a patient in another state.  The AMA: “This provision would deprive TRICARE beneficiaries of essential protections by fundamentally subverting and undermining existing state-based patient safety protections that are currently in force, and remove an essential mechanism used by states to ensure medical care provided to patients in their state meets acceptable standards of care.”  They both urged reliance upon the interstate licensing compact of the Federation of State Medical Boards as a viable alternative.

            The Association of State and Provincial Psychology Boards (ASPPB) has now established the Psychology Interjurisdictional Compact (PSYPACT) which is an interstate compact designed specifically to facilitate telehealth and the temporary face-to-face practice of psychology across jurisdictional boundaries.  Thanks to the vision of ASPPB CEO Steve DeMers, this effort has been endorsed in principle by the APA Council of Representatives.  The next step – having our State Associations appreciate the importance of “Catching the Wave” and enacting timely legislation.  “So hoist up the John B’s sail.”  Aloha,

Pat DeLeon, former APA President – Division 29 – November, 2016

 

WHY DON’T YOU LET ME GO HOME

  The Importance of Pursuing One's Passion:  It is exciting to reflect upon the challenges which dedicated colleagues have willingly embraced, especially when they are serving the "public good."  Two of our true RxP pioneers, who from the beginning have been on the front-line treating those in need of appropriate psychopharmacological care, have recently joined forces to promote global mental health.  New Mexico's Elaine LeVine and USAF (Ret.) Elaine Foster, who are among our earliest prescribing psychologists, have partnered to take on a weighty challenge indeed – global mental health.  According to the World Health Organization (WHO), half of all countries in the world have less than one psychiatrist per 100,000 people, and a third of all countries have no mental health programs at all.  Access and quality of care are extremely critical within the U.S. and are even more striking in middle- and low-income countries.  Our colleagues are well known for taking an unconventional slant on traditional medicine through their Psychobiosocial Model of Care.  They emphasize psychological factors in all aspects of evaluation and treatment; the more traditional medical school "biopsychosocial" model typically emphasizes body over mind (the physical over the psyche).

            WHO outlines the evolution of integrated care for mental health providers through a concept called "task shifting."  This is a process of expanded training for the healthcare workforce.  The goal is to empower health workers to better assist those in need.  In many countries there are few medical practitioners and the populations they serve are so vast that they are often not able to provide day-by-day services to their patients.  Task shifting allows a mental health worker to make recommendations to a primary care doctor regarding treatment options, based on augmented training in psychopharmacology from a psychobiosocial perspective.

            Our dedicated colleagues have moved beyond the theoretical concept of task shifting by launching a nonprofit organization, RxP International.  The organization's mission is to provide training in psychiatric medications as an adjunct to the many types of therapies that can be used in place of medicine.  In order to make rational recommendations about when medications should be avoided or discontinued, a mental health provider must understand when, how, and why they are used in the first place.  Helping practitioners gain the information and skills of this psychobiosocial model so that they consult effectively with medical personnel who are prescribing psychotropics is clearly a social justice concern since the focus is teaching people to better help themselves.

            In order to reach the broadest population, RxP international has designed courses that can be offered through distance learning and an open communication forum.  The courses target the most commonly diagnosed conditions, such as anxiety, depression, and psychosis, along with special populations, such as the elderly and children.  The online forum is actively managed to help student-providers share their unique experiences and needs from their place in the world.  In addition to providing a more personalized educational experience, the information from this forum will be used by the course developers to gain a better understanding of mental health needs and interests around the globe.  The RxP International signature course is a one-hour presentation on social justice, explaining the philosophy behind the movement and case studies on the New Mexico-Mexico border.

            In many ways, this vision is targeting the need of those front-line practitioners who are addressing society's real needs (i. e., those within the VA, DoD, state mental health systems, and federally qualified community health centers (FQHCs)).  The underlying goal is to provide readily available quality psychopharmacological expertise for dedicated public servants who need access to practical information, regardless of whether or not they receive a formal credential.   "We want to create a dynamic learning environment where anyone, regardless of their formal professional discipline, who wants to expand their clinical skills anywhere in the world can join this social justice movement" [Elaine Foster].  Current faculty include: Elaine Foster, Elaine LeVine, Mark Muse; Mitchell Simson, MD; and John Preston.  RxP International will be enlarging their number of offerings as the curriculum undergoes future iterations.  Their website – www.rxpint.org.

            One of psychology's first RxP training programs was developed by former Division 55 (American Society for the Advancement of Pharmacotherapy) President Bob McGrath at Fairleigh Dickinson University.  Bob is currently the university's Director of Integrated Care for the Underserved of Northeastern New Jersey – pursuing his passion for furthering psychology's involvement in serving those "most-in-need" by working closely with FQHCs.  With the recent legislative success in Iowa, I asked what was their enrollment.  Anne Farrar-Anton, the new director, responded from 38-45 new students each year, which is quite impressive.  Recall that in Denver, Bethe Lonning pointed out that although it did take Iowa a decade to enact RxP legislation, since 2011 they had only needed to raise $3,535.50.  The key to their success was grassroots campaigning and believing that their agenda was important for the citizens of Iowa.  Accordingly, we would suggest that as the number of practicing psychologists obtaining this specialized training continues to increase and as the media continues to focus upon the pressing needs for quality mental health care (the VA reports that every day 20 Veterans commit suicide) more and more states will achieve legislative success.

            A Fascinating Training Opportunity:  "The Military Contingency Medicine (MCM) course, which includes the field training exercise called 'Bushmaster', epitomizes the mission of USUHS: preparing health care providers to operate in any environment around the world.  There are two phases to the exercise and each phase is important.  The first phase is a two-week didactic experience that ranges from dental emergencies in the field to the United States strategic goals of Global Health Engagement.  The practical knowledge imparted is important, but what will last personally is an epiphany moment of recognizing 'Military Health' as its own unique specialty, a conceptualization of both the population I will treat and the role I will fulfill.  The second phase of MCM is Bushmaster, which lasts six days at a military installation in Pennsylvania.  I participated by providing mental health expertise and support to the main body of troops training.  It was an impressive operation and some of the highest-quality training in my military career.  More than that, it had the unbeatable quality inherent to much of military life, camaraderie and fun of being part of a large group of people with a shared goal.  However, the truly lasting effect of Bushmaster will be the exchange of ideas and the relationships built between our graduate nursing students, international participants, medical students, faculty, USUHS alumni, and practicing providers from across the country.  People I am guaranteed to cross paths with again, both stateside and across the world on any given mission" [Doug Taylor, USUHS mental health DNP student].

            Evolving Approaches to the Future:  With the enactment of President Obama's Patient Protection and Affordable Care Act (ACA), the delivery of health care services within our nation is steadily evolving towards integrated systems of care, rather than maintaining our historical reliance on independent practice models.  The federal government, and particularly the Departments of Defense (DoD) and Veterans Affairs (VA), have been on the cutting-edge of this movement.  This was evident at the town hall meeting hosted last year by then-FPA President Lori Butts during the Florida Psychological Association's 2015 Annual Convention, as her VA colleagues described their ongoing successes and challenges in meeting the mental health needs of their beneficiaries utilizing the maturing VA telehealth capabilities.

Licensure mobility is one of the new challenges facing practitioners of all disciplines who are interested in providing care in the 21^st Century.  Why should the locus of where one practices – especially in today's virtual lifespace – continue to be a determining factor of one's scope of practice?  In October, 1998 the Pew Health Professions Commission, chaired by the former Senate Majority Leader George Mitchell, recommended: "Congress should establish a national policy advisory body that will research, develop and publish national scopes of practice and continuing competency standards for state legislatures to implement."  This summer the VA proposed to permit full practice authority for its Advanced Practice Registered Nurses (APRNs) relying upon its federal supremacy authority.  By the close of the public commentary period, an extraordinary 223,000 comments had been received approximately 60% supportive.  Under the leadership of APA immediate Past-President Barry Anton and President-Elect Tony Puente, 16 former APA Presidents submitted a letter in support of the VA's proposal.  The APA Practice Organization signed on to a similar statement as a member of the Coalition for Patients' Rights, along with the American Physical Therapy Association.  The American Association of Colleges of Pharmacy and the Federal Trade Commission also submitted highly supportive comments.  It is significant that this proposal would only impact federal nurses working within VA facilities.

From a public policy perspective, the issue of licensure mobility becomes significantly more complex when one contemplates providing federal reimbursement to private sector clinicians for serving the health care needs of federal beneficiaries via telehealth.  The Senate Fiscal Year 2017 National Defense Authorization Act (S. 2943) would authorize the military's TRICARE program to reimburse for telehealth, including mobile health applications.  One aspect of this proposed authority, however, provides that for purposes of reimbursement, licensure, and professional liability relating to the provision of telehealth services, providers shall be considered to be furnishing such services at their location and not at the location of the patient.  In response, the AMA and the American Association of Family Physicians (AAFP) expressed the concern that this approach would essentially create a workaround to medical licensure and lead to physicians who aren't accountable to any medical board, since the board in the patient's state would not be able to regulate an out-of-state physician and the board in the physician's home state could not regulate an interaction with a patient in another state.  The AMA: "This provision would deprive TRICARE beneficiaries of essential protections by fundamentally subverting and undermining existing state-based patient safety protections that are currently in force, and remove an essential mechanism used by states to ensure medical care provided to patients in their state meets acceptable standards of care."  They both urged reliance upon the interstate licensing compact of the Federation of State Medical Boards as a viable alternative.

            The Association of State and Provincial Psychology Boards (ASPPB) has now established the Psychology Interjurisdictional Compact (PSYPACT) which is an interstate compact designed specifically to facilitate telehealth and the temporary face-to-face practice of psychology across jurisdictional boundaries.  Thanks to the vision of ASPPB CEO Steve DeMers, this effort has been endorsed in principle by the APA Council of Representatives.  The next step – having our State Associations appreciate the importance of "Catching the Wave" and enacting timely legislation.  "So hoist up the John B's sail."  Aloha,

Pat DeLeon, former APA President – Division 29 – November, 2016

 

Sent from my iPhone

ALOHA - D55 column

“AND WHEN I REACH THE OTHER SIDE”

            An Inspirational National Vision:  This fall a number of faculty and graduate students in psychology and nursing at the USUHS were invited to attend Give an Hour’s “A Celebration of Service” highlighted by a special Benefit Concert at the Daughters of the American Revolution (DAR) Constitution Hall by Chris and Morgan Stapleton.  Give an Hour Founder and President Barbara Van Dahlen and her colleagues have now provided over 200,000 hours of free mental health care (valued at over $20 million) to our nation’s active duty personnel, veterans, and their families.  What began as a focus on providing needed clinical services has evolved over the past 11 years into an impressive national Campaign to Change Direction focused on how all of us view mental health care.  Barbara has constantly reminded her audiences that the stigma surrounding mental health care is not limited to the military population, nor are the 20 suicides a day by Veterans an isolated problem.  As President and Michelle Obama have movingly proclaimed, all Americans must learn to pay attention to their emotional well-being.  Integrated care, and especially addressing the psychosocial-cultural-economic aspects of primary care, is a high priority of the President’s landmark Patient Protection and Affordable Care Act (ACA).

            This year Barbara has focused upon the role of motion pictures in shaping our nation’s attitudes and expectations (i.e., our culture).  Last year Brian Wilson of the Beach Boys personally participated in Give an Hour events bringing a personal face to the challenge of coping with mental illness in the bio-pic about his life, Love & Mercy.  This year Academy Award nominated filmmaker Oren Moverman discussed the emotional messages incorporated into a number of his films, including one (Time Out of Mind) in which Richard Gere played the role of a homeless individual – experiencing thousands of New Yorkers walking on-bye completely ignoring him (as if he simply did not exist).  Randi Silverman’s No Letting Go, also showcased at this year’s Celebration of Service, was particularly moving in describing one family’s struggle to cope with their son’s emotional instability – they possessed financial resources, but for so long could not find the necessary appropriate care.

            To date, over 330 organizations, including the American Psychological Association (APA), have joined with Give an Hour to “walk the talk.”  We were proud to see special events hosted at both the Canadian Embassy and APA’s new Spire conference center where psychologist and Give an Hour Advisory Board member Randy Phelps served as master of ceremonies for an evening that was attended by APA Interim CEO Cynthia Belar and Nick Puente, the APA’s President-Elect’s son, since Hurricane Matthew prevented Tony’s presence.  These partnerships across the public, private, and international sectors are critical to Changing the Direction.  The Five Signs of emotional suffering are -- Change in Personality; Agitation; Withdrawal; Lack of Personal Care; and, Hopelessness.  Just as we all know the signs of a heart attack, all Americans – civilians, service members, and Veterans – must now learn the signs of emotional suffering.

            A Critical Local Vision:  Over the years, we have come to appreciate that in order to accomplish substantive policy change, one must possess both a broad overarching objective and the equally important ability to engage those on the front-line in implementing the necessary foundational steps.  Division 55’s former President (2004) and current Council of Representatives member (2017-2019) Beth Rom-Rymer and her Illinois colleagues were successful during the summer of 2014 in having their prescriptive authority (RxP) legislation enacted into public law.  Currently, they are in the midst of their implementation process, which includes accelerating support for continuing legislative changes.

Beth: “We held a networking event in Chicago this fall.  Attendees included: prescribing psychology trainees from around the State of Illinois; graduate students who are hoping to enroll in training programs to become prescribing psychologists; leaders from the Illinois Psychological Association; prescribing psychology trainees from other states and Canada; leaders in Illinois and elsewhere who are creating educational and training opportunities for the prescribing psychology trainees; a key researcher who will be working with us to assess the effectiveness of prescribing psychologists; and supporters of our prescriptive authority Movement.  Seventy-five people attended the event.  The excitement in the room was palpable!”

“As one psychologist wrote: ‘I enjoyed meeting so many wonderful people and appreciate being a part of such an important movement.  I am always moved and inspired by the passionate unwavering drive to enhance the care and reach underserved populations.’  Another psychologist wrote: ‘It was nice to see others appreciate what has been accomplished: bringing psychopharmacology to psychology and to those who are underserved.  It’s going to be so important for mental health moving forward!  I’m really proud to witness it up close as it emerges.’  Yet another psychologist, who, at 84, is our oldest psychologist in training to become a prescriber, wrote: ‘I wish I had spoken more about all the wonderful things I have learned at FDU [The program founded by Bob McGrath at Fairleigh Dickinson University] and the benefit to me and my patients.  I know, for example, that I collaborate more expertly, now, with physicians because of my newly-acquired knowledge of pharmacokinetics and pharmacodynamics – I shared [your recognizing my accomplishments] with my granddaughter who is a pre-med freshman this fall.  I will take my [PEP] exam in 2017….  Meeting you changed my life in so many ways.”  Finally, ‘The evening was delightful, as always, and the purpose, excellent.  It was nice to see others appreciate what I have seen you accomplish.  You could, in fact, move the masses to bring democracy to a small country.  (Maybe that’s next?!)’  And, that is only the beginning.”

An Inclusive Perspective:  The specifics of the Illinois RxP legislation were crafted to address their state’s unique political and social-environmental context, particularly with its emphasis upon undergraduate education.  One must appreciate that there are numerous ways to approach providing increased access to quality psychopharmacological therapies.  Our clinical pharmacy colleagues, for example, have generally taken the Pharmacist Collaborative Practice Agreement (CPA) approach, with almost every state (except Alabama) now having enacted some form of this legislation and regulations.  CPAs effectively: * Create a formal relationship between pharmacists and physicians or other providers.  * Define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions.  And, * Many are used to expand the depth and breadth of services the pharmacist can provide to patients and the healthcare team.

Psychology should appreciate that collaborative team-based care represents another express priority of the ACA.  Psychologist Karen Pellegrin, at the University of Hawaii at Hilo Daniel K. Inouye College of Pharmacy, conducted a two year evaluation of the cost-effectiveness of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm).  Slightly over 2,000 elderly high-risk patients were involved.  The Pharm2Pharm model resulted in an estimated 36% reduction in the medication-related hospitalization rate for older adults and a 2.6:1 return on investment, highlighting the value of pharmacists as drug therapy experts in geriatric care.  The estimated annualized cost of avoided admissions was $6.6 million.  Karen’s findings are very impressive!  We would rhetorically ask: Are our state psychological and nursing associations conducting joint psychology/nursing-pharmacy initiatives, including providing interdisciplinary collaborative panel presentations at their respective annual state association meetings?

That Personal Perspective:  As Barbara keeps stressing, mental health issues impact all Americans.  “Thank you so much for advocating for and helping people with mental illness.  I am the sister of a bright, creative, kind, and loving woman with bi-polar disorder, who is actually doing remarkably well right now.  There was a time though, when she wasn’t.  For many, many years she struggled with clinical depression, suicide ideation, delusions, paranoia, anxiety, and more.  She has been in and out of hospitals, worked with dozens of doctors, tried many different meds and combinations, and even ECT.  We are so thankful that she has finally found effective treatment, a great team of health care providers, and has been well for several years.  I remember watching my sister change during her early 20s… and witnessing the bi-polar disorder present.  My role shifted from her 19 year old, little sister to her relentless advocate and caregiver for more than a decade.  That experience shaped my career path (into social work), and more importantly, my passion for helping people with mental illness and their families.  I want to share with you a blog that Susan Reinhard and I recently posted: The Most Invisible Family Caregivers.  In it, we focus on the people who provide care and support to adults with mental health issues, discuss the unique challenges they face, provide resources and encourage dialogue… all in the hopes of reducing stigma and isolation.”  “And I’ll be back again, again, and again…” [Jennifer Peed, AARP Public Policy Institute].  Aloha,

Pat DeLeon, former APA President – Division 55 -- October, 2016

 

AND WHEN I REACH THE OTHER SIDE

  An Inspirational National Vision:  This fall a number of faculty and graduate students in psychology and nursing at the USUHS were invited to attend Give an Hour's "A Celebration of Service" highlighted by a special Benefit Concert at the Daughters of the American Revolution (DAR) Constitution Hall by Chris and Morgan Stapleton.  Give an Hour Founder and President Barbara Van Dahlen and her colleagues have now provided over 200,000 hours of free mental health care (valued at over $20 million) to our nation's active duty personnel, veterans, and their families.  What began as a focus on providing needed clinical services has evolved over the past 11 years into an impressive national Campaign to Change Direction focused on how all of us view mental health care.  Barbara has constantly reminded her audiences that the stigma surrounding mental health care is not limited to the military population, nor are the 20 suicides a day by Veterans an isolated problem.  As President and Michelle Obama have movingly proclaimed, all Americans must learn to pay attention to their emotional well-being.  Integrated care, and especially addressing the psychosocial-cultural-economic aspects of primary care, is a high priority of the President's landmark Patient Protection and Affordable Care Act (ACA).

            This year Barbara has focused upon the role of motion pictures in shaping our nation's attitudes and expectations (i.e., our culture).  Last year Brian Wilson of the Beach Boys personally participated in Give an Hour events bringing a personal face to the challenge of coping with mental illness in the bio-pic about his life, Love & Mercy.  This year Academy Award nominated filmmaker Oren Moverman discussed the emotional messages incorporated into a number of his films, including one (Time Out of Mind) in which Richard Gere played the role of a homeless individual – experiencing thousands of New Yorkers walking on-bye completely ignoring him (as if he simply did not exist).  Randi Silverman's No Letting Go, also showcased at this year's Celebration of Service, was particularly moving in describing one family's struggle to cope with their son's emotional instability – they possessed financial resources, but for so long could not find the necessary appropriate care.

            To date, over 330 organizations, including the American Psychological Association (APA), have joined with Give an Hour to "walk the talk."  We were proud to see special events hosted at both the Canadian Embassy and APA's new Spire conference center where psychologist and Give an Hour Advisory Board member Randy Phelps served as master of ceremonies for an evening that was attended by APA Interim CEO Cynthia Belar and Nick Puente, the APA's President-Elect's son, since Hurricane Matthew prevented Tony's presence.  These partnerships across the public, private, and international sectors are critical to Changing the Direction.  The Five Signs of emotional suffering are -- Change in Personality; Agitation; Withdrawal; Lack of Personal Care; and, Hopelessness.  Just as we all know the signs of a heart attack, all Americans – civilians, service members, and Veterans – must now learn the signs of emotional suffering.

            A Critical Local Vision:  Over the years, we have come to appreciate that in order to accomplish substantive policy change, one must possess both a broad overarching objective and the equally important ability to engage those on the front-line in implementing the necessary foundational steps.  Division 55's former President (2004) and current Council of Representatives member (2017-2019) Beth Rom-Rymer and her Illinois colleagues were successful during the summer of 2014 in having their prescriptive authority (RxP) legislation enacted into public law.  Currently, they are in the midst of their implementation process, which includes accelerating support for continuing legislative changes.

Beth: "We held a networking event in Chicago this fall.  Attendees included: prescribing psychology trainees from around the State of Illinois; graduate students who are hoping to enroll in training programs to become prescribing psychologists; leaders from the Illinois Psychological Association; prescribing psychology trainees from other states and Canada; leaders in Illinois and elsewhere who are creating educational and training opportunities for the prescribing psychology trainees; a key researcher who will be working with us to assess the effectiveness of prescribing psychologists; and supporters of our prescriptive authority Movement.  Seventy-five people attended the event.  The excitement in the room was palpable!"

"As one psychologist wrote: 'I enjoyed meeting so many wonderful people and appreciate being a part of such an important movement.  I am always moved and inspired by the passionate unwavering drive to enhance the care and reach underserved populations.'  Another psychologist wrote: 'It was nice to see others appreciate what has been accomplished: bringing psychopharmacology to psychology and to those who are underserved.  It's going to be so important for mental health moving forward!  I'm really proud to witness it up close as it emerges.'  Yet another psychologist, who, at 84, is our oldest psychologist in training to become a prescriber, wrote: 'I wish I had spoken more about all the wonderful things I have learned at FDU [The program founded by Bob McGrath at Fairleigh Dickinson University] and the benefit to me and my patients.  I know, for example, that I collaborate more expertly, now, with physicians because of my newly-acquired knowledge of pharmacokinetics and pharmacodynamics – I shared [your recognizing my accomplishments] with my granddaughter who is a pre-med freshman this fall.  I will take my [PEP] exam in 2017….  Meeting you changed my life in so many ways."  Finally, 'The evening was delightful, as always, and the purpose, excellent.  It was nice to see others appreciate what I have seen you accomplish.  You could, in fact, move the masses to bring democracy to a small country.  (Maybe that's next?!)'  And, that is only the beginning."

An Inclusive Perspective:  The specifics of the Illinois RxP legislation were crafted to address their state's unique political and social-environmental context, particularly with its emphasis upon undergraduate education.  One must appreciate that there are numerous ways to approach providing increased access to quality psychopharmacological therapies.  Our clinical pharmacy colleagues, for example, have generally taken the Pharmacist Collaborative Practice Agreement (CPA) approach, with almost every state (except Alabama) now having enacted some form of this legislation and regulations.  CPAs effectively: * Create a formal relationship between pharmacists and physicians or other providers.  * Define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions.  And, * Many are used to expand the depth and breadth of services the pharmacist can provide to patients and the healthcare team.

Psychology should appreciate that collaborative team-based care represents another express priority of the ACA.  Psychologist Karen Pellegrin, at the University of Hawaii at Hilo Daniel K. Inouye College of Pharmacy, conducted a two year evaluation of the cost-effectiveness of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm).  Slightly over 2,000 elderly high-risk patients were involved.  The Pharm2Pharm model resulted in an estimated 36% reduction in the medication-related hospitalization rate for older adults and a 2.6:1 return on investment, highlighting the value of pharmacists as drug therapy experts in geriatric care.  The estimated annualized cost of avoided admissions was $6.6 million.  Karen's findings are very impressive!  We would rhetorically ask: Are our state psychological and nursing associations conducting joint psychology/nursing-pharmacy initiatives, including providing interdisciplinary collaborative panel presentations at their respective annual state association meetings?

That Personal Perspective:  As Barbara keeps stressing, mental health issues impact all Americans.  "Thank you so much for advocating for and helping people with mental illness.  I am the sister of a bright, creative, kind, and loving woman with bi-polar disorder, who is actually doing remarkably well right now.  There was a time though, when she wasn't.  For many, many years she struggled with clinical depression, suicide ideation, delusions, paranoia, anxiety, and more.  She has been in and out of hospitals, worked with dozens of doctors, tried many different meds and combinations, and even ECT.  We are so thankful that she has finally found effective treatment, a great team of health care providers, and has been well for several years.  I remember watching my sister change during her early 20s… and witnessing the bi-polar disorder present.  My role shifted from her 19 year old, little sister to her relentless advocate and caregiver for more than a decade.  That experience shaped my career path (into social work), and more importantly, my passion for helping people with mental illness and their families.  I want to share with you a blog that Susan Reinhard and I recently posted: The Most Invisible Family Caregivers.  In it, we focus on the people who provide care and support to adults with mental health issues, discuss the unique challenges they face, provide resources and encourage dialogue… all in the hopes of reducing stigma and isolation."  "And I'll be back again, again, and again…" [Jennifer Peed, AARP Public Policy Institute].  Aloha,

Pat DeLeon, former APA President – Division 55 -- October, 2016

 

Sent from my iPhone