Division 19 column

“AROUND NASSAU TOWN WE DID ROAM”

            2016 is a Presidential election year and it is rarely to either party’s advantage to be engaged in a prolonged legislative session, rather than being “freed up” to be back home mingling with voters.  One would expect the Department of Defense (DoD) appropriations and authorization bills will be quickly “marked-up” and incorporated in a short-term Continuing Resolution (i.e., funding made available for FY’17) until after the election, with the Congress then returning to complete their deliberations quickly – the ultimate decisions depending upon how the nation voted.  The recent Committee “requests” for personal Member recommendations is consistent with this scenario.  Working on the Hill provides one with an appreciation for the gradual “waves of change” which can result in substantive modifications in the status quo.  One can almost feel when this “ebb and flow” occurs.

            A Changing Dialogue:  One of Senator Inouye’s first amendments to the DoD CHAMPUS program, back in the late 1970’s, was to allow beneficiaries direct access to the services of certified nurse midwives.  When he offered that amendment he had also included a provision to recognize psychiatric mental health nurse practitioners.  His colleagues were very hesitant to support the latter; however, they enthusiastically endorsed the nurse midwifery provision with several senior members commenting that they themselves had been delivered by a nurse midwife.

Times have changed, especially surrounding our nation’s dialogue on mental/behavioral health.  When President Obama addressed the adverse consequences of solitary confinement, he was alluding to introductory psychology.  Mental health courts, including those for Veterans, are increasing in number.  Earlier this year, the U.S. Preventive Services Task Force recommended for the first time that women be screened during pregnancy and after childbirth for depression as part of their normal health-care routine.  Neil Kirschner, a former APA Congressional Science Fellow, facilitated the American College of Physicians (ACP) support for the integration of behavioral health care into primary care and having all health care professionals consider the behavioral and physical health of their patient if they are to be treated as a “whole person.”  Leading the way was U.S. Army Surgeon General Patty Horoho’s vision of the healthcare “Lifespace” where individuals and their families make the choices that really impact their lives and health, and her personal collaboration with Barbara Van Dahlen of Give an Hour.

            During deliberations on the FY’16 DoD Appropriations bill, the U.S. Senate included several provisions which are directly relevant to military psychologists and behavioral health providers.  This in itself is most impressive.  “The Committee recognizes that servicemembers and their families face unique stresses beyond those of everyday life.  After over a decade of war, the need for mental health professionals in the Department is at an all-time high, and the Committee believes that every beneficiary of the Military Health System should have timely access to mental health services.  However, the Committee is concerned with the Department’s inability to recruit and retain enough psychiatrists, psychologists, social workers, nurse practitioners and registered nurses to provide adequate mental healthcare….  (T)he Assistant Secretary of Defense (Health Affairs) is directed to prepare… a review of these estimates as well as an outline of current challenges in recruiting and retaining mental health professionals by the Department of Defense.”

            The Uniformed Services University of the Health Sciences (USUHS):  USUHS’s mission is to be responsive to the unique needs of DoD and the USPHS; the four Surgeon Generals serving on its Board of Regents.  There have been increasing collaborative efforts between the leadership of the department of psychology and psychiatric nursing, focusing upon interprofessional models of care and training, which are a high priority for the University’s President.  For example, they jointly utilize the simulation center with its standardized patients (i.e., skilled actors) and have participated together in the signature training event “Operation Bushmaster.”

Recently, David Riggs, newly appointed psychology chair, and his nursing counterpart, Jess Calohan, have begun exploring ways to expand these earlier efforts; perhaps by having targeted modules integrated into their respective curricula.  It would be relatively straightforward to re-start the psychopharmacology training program given that USUHS nurses are already trained to provide that clinical service.  Of interest, the Senate Appropriations Committee had noted: “Prescription Effectiveness of Psychotropic Medications. – The Committee supports the Department’s efforts to treat patients diagnosed with behavioral health disorders and believes that the ongoing efforts to use database-supported methods in order to increase the accuracy and effectiveness of prescription practices for mental health medications may not only achieve cost savings but also improve patient care.  The Committee encourages the expansion of this research to additional sites as preliminary findings have shown promising results.”

We would rhetorically ask: Does psychology want to be involved and remain relevant?  At one point, we asked: Where in this discussion were those psychologists who were themselves Veterans?  William Danton, a veteran and former Associate Chief of Staff for Mental Health in the VA, responded that he is vehemently opposed to RxP for psychologists precisely because he values quality of care!  During our subsequent discussion: “Of course I value my colleagues and I’m sure they could do as well or better than our psychiatry brethren.  It is the plethora of dangerous and often ineffective psychiatric medications I object to.  It is the clear and inappropriate influence of pharma that will indiscriminately poison practitioners of all professions.  If only psychologists were immune to that.  However, as we have seen from the DoD debacle, money often drives practice.”  Reasonable professionals can clearly differ.

Watching the Shifting Currents:  Last year the DoD Appropriations conferees included language that may be prophetic.  “Concerns remain regarding the transfer of funds from the In-House Care budget sub-activity to pay for contractor-provided medical care.  To limit such transfers and improve oversight within the Defense Health Program operation and maintenance account, the agreement includes a provision which caps the funds available for Private Sector Care under the TRICARE program subject to prior approval reprogramming procedures.”  On August 21, 1959 Hawaii achieved Statehood.  Citizens living on the neighboring islands who required inpatient care relied upon the State to provide these services, as one of its most basic responsibilities.  On January 14, 2016 Hawaii’s Governor signed a transfer agreement allowing Kaiser Permanente to assume control of the three financially-struggling public hospitals on Maui.  This action is estimated to save the State $260 million over 10 years.  Whether in the long run this is a good policy or not, rests upon one’s fundamental belief in the role of government.  We would proffer that a similar debate exists regarding the delivery of health care to our nation’s active duty personnel, their families, and our Veterans.  “I feel so broke up, I wanna go home.”  Aloha,

Pat DeLeon, former APA President – Division 19 – February, 2016

 

 

“AROUND NASSAU TOWN WE DID ROAM”

 2016 is a Presidential election year and it is rarely to either party's advantage to be engaged in a prolonged legislative session, rather than being "freed up" to be back home mingling with voters.  One would expect the Department of Defense (DoD) appropriations and authorization bills will be quickly "marked-up" and incorporated in a short-term Continuing Resolution (i.e., funding made available for FY'17) until after the election, with the Congress then returning to complete their deliberations quickly – the ultimate decisions depending upon how the nation voted.  The recent Committee "requests" for personal Member recommendations is consistent with this scenario.  Working on the Hill provides one with an appreciation for the gradual "waves of change" which can result in substantive modifications in the status quo.  One can almost feel when this "ebb and flow" occurs.

            A Changing Dialogue:  One of Senator Inouye's first amendments to the DoD CHAMPUS program, back in the late 1970's, was to allow beneficiaries direct access to the services of certified nurse midwives.  When he offered that amendment he had also included a provision to recognize psychiatric mental health nurse practitioners.  His colleagues were very hesitant to support the latter; however, they enthusiastically endorsed the nurse midwifery provision with several senior members commenting that they themselves had been delivered by a nurse midwife.

Times have changed, especially surrounding our nation's dialogue on mental/behavioral health.  When President Obama addressed the adverse consequences of solitary confinement, he was alluding to introductory psychology.  Mental health courts, including those for Veterans, are increasing in number.  Earlier this year, the U.S. Preventive Services Task Force recommended for the first time that women be screened during pregnancy and after childbirth for depression as part of their normal health-care routine.  Neil Kirschner, a former APA Congressional Science Fellow, facilitated the American College of Physicians (ACP) support for the integration of behavioral health care into primary care and having all health care professionals consider the behavioral and physical health of their patient if they are to be treated as a "whole person."  Leading the way was U.S. Army Surgeon General Patty Horoho's vision of the healthcare "Lifespace" where individuals and their families make the choices that really impact their lives and health, and her personal collaboration with Barbara Van Dahlen of Give an Hour.

            During deliberations on the FY'16 DoD Appropriations bill, the U.S. Senate included several provisions which are directly relevant to military psychologists and behavioral health providers.  This in itself is most impressive.  "The Committee recognizes that servicemembers and their families face unique stresses beyond those of everyday life.  After over a decade of war, the need for mental health professionals in the Department is at an all-time high, and the Committee believes that every beneficiary of the Military Health System should have timely access to mental health services.  However, the Committee is concerned with the Department's inability to recruit and retain enough psychiatrists, psychologists, social workers, nurse practitioners and registered nurses to provide adequate mental healthcare….  (T)he Assistant Secretary of Defense (Health Affairs) is directed to prepare… a review of these estimates as well as an outline of current challenges in recruiting and retaining mental health professionals by the Department of Defense."

            The Uniformed Services University of the Health Sciences (USUHS):  USUHS's mission is to be responsive to the unique needs of DoD and the USPHS; the four Surgeon Generals serving on its Board of Regents.  There have been increasing collaborative efforts between the leadership of the department of psychology and psychiatric nursing, focusing upon interprofessional models of care and training, which are a high priority for the University's President.  For example, they jointly utilize the simulation center with its standardized patients (i.e., skilled actors) and have participated together in the signature training event "Operation Bushmaster."

Recently, David Riggs, newly appointed psychology chair, and his nursing counterpart, Jess Calohan, have begun exploring ways to expand these earlier efforts; perhaps by having targeted modules integrated into their respective curricula.  It would be relatively straightforward to re-start the psychopharmacology training program given that USUHS nurses are already trained to provide that clinical service.  Of interest, the Senate Appropriations Committee had noted: "Prescription Effectiveness of Psychotropic Medications. – The Committee supports the Department's efforts to treat patients diagnosed with behavioral health disorders and believes that the ongoing efforts to use database-supported methods in order to increase the accuracy and effectiveness of prescription practices for mental health medications may not only achieve cost savings but also improve patient care.  The Committee encourages the expansion of this research to additional sites as preliminary findings have shown promising results."

We would rhetorically ask: Does psychology want to be involved and remain relevant?  At one point, we asked: Where in this discussion were those psychologists who were themselves Veterans?  William Danton, a veteran and former Associate Chief of Staff for Mental Health in the VA, responded that he is vehemently opposed to RxP for psychologists precisely because he values quality of care!  During our subsequent discussion: "Of course I value my colleagues and I'm sure they could do as well or better than our psychiatry brethren.  It is the plethora of dangerous and often ineffective psychiatric medications I object to.  It is the clear and inappropriate influence of pharma that will indiscriminately poison practitioners of all professions.  If only psychologists were immune to that.  However, as we have seen from the DoD debacle, money often drives practice."  Reasonable professionals can clearly differ.

Watching the Shifting Currents:  Last year the DoD Appropriations conferees included language that may be prophetic.  "Concerns remain regarding the transfer of funds from the In-House Care budget sub-activity to pay for contractor-provided medical care.  To limit such transfers and improve oversight within the Defense Health Program operation and maintenance account, the agreement includes a provision which caps the funds available for Private Sector Care under the TRICARE program subject to prior approval reprogramming procedures."  On August 21, 1959 Hawaii achieved Statehood.  Citizens living on the neighboring islands who required inpatient care relied upon the State to provide these services, as one of its most basic responsibilities.  On January 14, 2016 Hawaii's Governor signed a transfer agreement allowing Kaiser Permanente to assume control of the three financially-struggling public hospitals on Maui.  This action is estimated to save the State $260 million over 10 years.  Whether in the long run this is a good policy or not, rests upon one's fundamental belief in the role of government.  We would proffer that a similar debate exists regarding the delivery of health care to our nation's active duty personnel, their families, and our Veterans.  "I feel so broke up, I wanna go home."  Aloha,

Pat DeLeon, former APA President – Division 19 – February, 2016

 

 

Sent from my iPhone

Division 29 February, 2016 column

“THESE BOOTS ARE MADE FOR WALKIN’”

            For the past several conventions, I have had the exciting opportunity to join with visionary colleagues (from a broad range of professional backgrounds) hosting symposia addressing the wide range of issues surrounding “meaningful retirement.”  All of us have noticed that a number of our well-known senior colleagues have “opted out” of their historical involvement within the APA governance, with even some Past Presidents no longer attending the annual conventions – perhaps as a result of “physical challenges.”  Involvement in APA has historically provided meaningful social and emotional support for all of us, not to mention considerable status and societal respect.  As psychologists, we know that this is important for one’s health and well-being.

This year in Denver, long time public servant Rod Baker will discuss his evolution towards writing that novel that he had always thought he would do in retirement – finding fun and a sense of accomplishment and purpose, such that he now looks forward to spending most of his time in retirement with that activity.  Walter Penk, last year’s recipient of an APF Gold Medal Award and now in his 80’s, continues to work tirelessly on behalf of our nation’s Veterans and especially those returning to universities as students.  Walter embraces three goals -- reading, writing, and running.  Running, as physical and mental health are essential; not just when young, but especially when older.  Ellen Cole has undertaken the challenge of confronting Aging Discrimination.  Still academically-based, the highlights of her journey include teaching Introductory Psychology to high school students, going back to school to earn her Master’s degree in Applied Positive Psychology (her biggest adventure), and continuing her active journal involvement.  Our audiences seem to enjoy themselves, suggesting additional topics for the following year; for example, the stress of dealing with major physical difficulties.  From our perspective, these thought-provoking discussions touch upon foundational issues that will increase in importance for all professional associations, as their membership gradually ages and their next generation matures and takes center stage.

            Over the years, APA has had truly outstanding individuals serving for a year in Washington, DC under its Congressional and Executive Branch Science Fellowship program.  During the 2003 Toronto convention, Fellow Neil Kirschner has opined: “More often than not, research findings in the legislative arena are only valued if consistent with conclusions based upon the more salient political decision factors.  Thus, within the legislative setting, research data are not used to drive decision-making decisions, but more frequently are used to support decisions made based upon other factors.  As psychologists, we need to be aware of this basic difference between the role of research in science settings and the legislative world.  It makes the role of the researcher who wants to put ‘into play’ available research results into a public policy deliberation more complex.  Data needs to be introduced, explained, or framed in a manner cognizant of the political exigencies.  Furthermore, it emphasizes the importance of efforts to educate our legislators on the importance and long-term effectiveness of basing decisions on quality research data.  If I’ve learned anything on the Hill, it is the importance of political advocacy if you desire a change in public policy.”  Neil will soon be “retiring” from the American College of Physicians (ACP) on his 70^th birthday.

            Under Neil’s guidance, the ACP Health and Public Policy Committee recently recommended: * That ACP support the integration of behavioral health care into primary care and encourage its members to address behavioral health issues within the limits of their competencies and resources.  * That ACP recommend that public and private health insurance payers, policymakers, and primary care and behavioral health care professionals work toward removing payment barriers that impede behavioral health and primary care integration.  Stakeholders should ensure the availability of adequate financial resources to support the practice infrastructure required to effectively provide such care.  * That ACP encourage efforts by federal and state governments, relevant training programs, and continuing education providers to ensure an adequate workforce to provide for integrated behavioral health care in the primary care setting.  * That ACP recommend that all relevant stakeholders initiate programs to reduce the stigma associated with behavioral health.  These must address the negative perceptions held by the general population and by many physicians and other health care professionals.  And, * Physicians and other health care professionals will have to consider the behavioral and physical health of the patient if they are to be treated as a “whole person.”

            Another psychologist visionary, Mitch Prinstein, recently conducted a survey of psychologists for Division 53 (the Society of Clinical Child and Adolescent Psychologists) exploring their perceptions of how the field will change in the next couple of decades.  There was a very impressive response rate with 619 individuals participating; 46.0% indicated they were practitioners, while 17.3% were students.  Independent practice and university-research were their two top workplaces.  When asked: “As compared to now, clinical psychologists will be engaged in much MORE... in 2032”; Clinical Services (26%) and Interdisciplinary Collaboration (21%) were the two top noted.  When asked: “In 2032, clinical psychologists will need to be much more competent in….”; Interdisciplinary Collaboration and Psychopharmacology, Prescribing, Medical Settings, received 10% of the vote.  Clinical Services received 23% of the vote; and of those votes, Technology Based Work received 16.2%, second only to Evidence-Based Practice in Psychology (EBPP) which received 30.9%.  Clearly, there is the growing perception in the field that significant change is upon us.

            The Next Generation:  Today’s champion for prescriptive authority (RxP) is Beth Rom-Rymer, a longtime member of the Council of Representatives.  “Probably my greatest inspiration, as I criss-cross Illinois and our country, talking about the mounting enthusiasm for prescriptive authority, are the words, themselves, of our (more than 100) prescribing psychologists in training:  ‘My decision to seek prescriptive authority is part of the natural evolution in my continuing efforts to serve underserved and Spanish-speaking communities.  It is borne from personal experience with trauma, as well as from my many work experiences in which I’ve seen patients wait for extended periods of time, and/or travel over 2 hours, one way, for a psychiatric appointment.  In my current and recent jobs, our institutions have struggled to hire psychiatrists.  However, we could not locate any candidates in over 2 years of active recruitment.  I want to meet these glaring needs.  As Illinois progresses, I look forward to collaborating with colleagues in other states so that prescribing psychologists become a national healthcare standard.’

            “Two of the largest Illinois State Universities (with tens of thousands of undergraduate students) have added undergraduate concentrations in a ‘pre-prescribing psychologist’ curriculum; and more than 20 hospitals and medical centers, statewide, are working, in collaboration with the Illinois Psychological Association (IPA), to provide medical rotations for the prescribing psychologist trainee.  While organized medicine and psychiatry had vociferously opposed the Illinois bill during the lobbying effort, now that the law has passed, both general medicine and psychiatry have been working hand-in-hand with us to implement the law and accelerate the integration of prescribing psychologists into the healthcare provider network statewide.

            “Under the leadership of prominent healthcare economist, Uwe Reinhardt, scholars at Princeton University’s Center for Health and Well-Being have been doing extensive research on the effects of healthcare providers’ expanded scope of practice on health status.  An article, soon to published, has been provisionally titled: ‘Just What the Nurse Practitioner Ordered: Independent Prescriptive Authority and Population Mental Health.’  One of the stunning preliminary results of this research (looking at mortality data from 1990 to 2013) is that states ‘that grant independent prescriptive authority to nurse practitioners experience, on average, a 12% reduction in ‘mental-health-related mortality’ (including suicides, deaths of unknown intent, and accidental deaths).  The results are more pronounced in areas with a low psychiatrist-to-population ratio and among populations with low levels of education.’  These scholars will also be looking at similar health status data from states that have granted prescriptive authority to psychologists.”

            Additional Reflections on the Hoffman Report:  Those attending the Toronto convention had to be impressed by the energy generated surrounding the release of the Hoffman Report.  Very dedicated and sincere colleagues were passionate about their conflicting views of what had transpired and what were the underlying causes/issues.  Accordingly, I subsequently asked a long-time colleague, whom I have tremendous respect for, for his/her perspective.  “Discussions regarding the Hoffman report continue.  In October, four psychologists named in the report issued a response that provided documentation refuting Hoffman’s central conclusion, namely, that military psychologists worked to keep ethics guidelines ‘loose’ in order to enable detainee abuse.  In fact, it appears that the very psychologists under scrutiny assisted in drafting Department of Defense policies designed to prevent detainee abuse.  One such policy, which US Army COL (Ret) Dr. Debra Dunivin helped draft, was itself contained in the Hoffman report supplemental materials and prohibited the very interrogation techniques Mr. Hoffman alleged military psychologists sought to permit.  In November, Division 19, the Society for Military Psychology, issued its own response to the Hoffman report which provided examples of what the Division felt was a deep seated anti-military bias in the report.  APA has yet to respond publicly to the substantive and compelling criticisms of the Hoffman report in either of these documents.  According to The New York Times, Mr. Hoffman has declined to comment on these points.

            “In addition, the Pentagon has brought forth serious concerns about the 2015 APA policy.  It seems that when they voted, many Council members did not realize the 2015 resolution would prevent military psychologists from providing psychological services to detainees.  In a letter to APA, Pentagon officials pointed out that this aspect of the resolution appears to violate Common Article 3 of the Geneva Conventions.  The Pentagon has asked APA to reconsider the blanket prohibition against psychologist involvement in interrogations.  The plan is for APA and DoD representatives to meet soon regarding APA policy and DoD concerns.  It will be critical for both sides to listen to one another carefully in order to craft policies that successfully integrate national security and respect for human rights.  As it moves forward, APA will need to consider how it views the appropriate role of a member association, that is, whether the association’s primary focus should be on promoting human rights, or rather on advancing the legitimate interests of all of its members.”  “Start Walkin’!”  Aloha,

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

 

 

THESE BOOTS ARE MADE FOR WALKIN’

For the past several conventions, I have had the exciting opportunity to join with visionary colleagues (from a broad range of professional backgrounds) hosting symposia addressing the wide range of issues surrounding "meaningful retirement."  All of us have noticed that a number of our well-known senior colleagues have "opted out" of their historical involvement within the APA governance, with even some Past Presidents no longer attending the annual conventions – perhaps as a result of "physical challenges."  Involvement in APA has historically provided meaningful social and emotional support for all of us, not to mention considerable status and societal respect.  As psychologists, we know that this is important for one's health and well-being.

This year in Denver, long time public servant Rod Baker will discuss his evolution towards writing that novel that he had always thought he would do in retirement – finding fun and a sense of accomplishment and purpose, such that he now looks forward to spending most of his time in retirement with that activity.  Walter Penk, last year's recipient of an APF Gold Medal Award and now in his 80's, continues to work tirelessly on behalf of our nation's Veterans and especially those returning to universities as students.  Walter embraces three goals -- reading, writing, and running.  Running, as physical and mental health are essential; not just when young, but especially when older.  Ellen Cole has undertaken the challenge of confronting Aging Discrimination.  Still academically-based, the highlights of her journey include teaching Introductory Psychology to high school students, going back to school to earn her Master's degree in Applied Positive Psychology (her biggest adventure), and continuing her active journal involvement.  Our audiences seem to enjoy themselves, suggesting additional topics for the following year; for example, the stress of dealing with major physical difficulties.  From our perspective, these thought-provoking discussions touch upon foundational issues that will increase in importance for all professional associations, as their membership gradually ages and their next generation matures and takes center stage.

            Over the years, APA has had truly outstanding individuals serving for a year in Washington, DC under its Congressional and Executive Branch Science Fellowship program.  During the 2003 Toronto convention, Fellow Neil Kirschner has opined: "More often than not, research findings in the legislative arena are only valued if consistent with conclusions based upon the more salient political decision factors.  Thus, within the legislative setting, research data are not used to drive decision-making decisions, but more frequently are used to support decisions made based upon other factors.  As psychologists, we need to be aware of this basic difference between the role of research in science settings and the legislative world.  It makes the role of the researcher who wants to put 'into play' available research results into a public policy deliberation more complex.  Data needs to be introduced, explained, or framed in a manner cognizant of the political exigencies.  Furthermore, it emphasizes the importance of efforts to educate our legislators on the importance and long-term effectiveness of basing decisions on quality research data.  If I've learned anything on the Hill, it is the importance of political advocacy if you desire a change in public policy."  Neil will soon be "retiring" from the American College of Physicians (ACP) on his 70^th birthday.

            Under Neil's guidance, the ACP Health and Public Policy Committee recently recommended: * That ACP support the integration of behavioral health care into primary care and encourage its members to address behavioral health issues within the limits of their competencies and resources.  * That ACP recommend that public and private health insurance payers, policymakers, and primary care and behavioral health care professionals work toward removing payment barriers that impede behavioral health and primary care integration.  Stakeholders should ensure the availability of adequate financial resources to support the practice infrastructure required to effectively provide such care.  * That ACP encourage efforts by federal and state governments, relevant training programs, and continuing education providers to ensure an adequate workforce to provide for integrated behavioral health care in the primary care setting.  * That ACP recommend that all relevant stakeholders initiate programs to reduce the stigma associated with behavioral health.  These must address the negative perceptions held by the general population and by many physicians and other health care professionals.  And, * Physicians and other health care professionals will have to consider the behavioral and physical health of the patient if they are to be treated as a "whole person."

            Another psychologist visionary, Mitch Prinstein, recently conducted a survey of psychologists for Division 53 (the Society of Clinical Child and Adolescent Psychologists) exploring their perceptions of how the field will change in the next couple of decades.  There was a very impressive response rate with 619 individuals participating; 46.0% indicated they were practitioners, while 17.3% were students.  Independent practice and university-research were their two top workplaces.  When asked: "As compared to now, clinical psychologists will be engaged in much MORE... in 2032"; Clinical Services (26%) and Interdisciplinary Collaboration (21%) were the two top noted.  When asked: "In 2032, clinical psychologists will need to be much more competent in…."; Interdisciplinary Collaboration and Psychopharmacology, Prescribing, Medical Settings, received 10% of the vote.  Clinical Services received 23% of the vote; and of those votes, Technology Based Work received 16.2%, second only to Evidence-Based Practice in Psychology (EBPP) which received 30.9%.  Clearly, there is the growing perception in the field that significant change is upon us.

            The Next Generation:  Today's champion for prescriptive authority (RxP) is Beth Rom-Rymer, a longtime member of the Council of Representatives.  "Probably my greatest inspiration, as I criss-cross Illinois and our country, talking about the mounting enthusiasm for prescriptive authority, are the words, themselves, of our (more than 100) prescribing psychologists in training:  'My decision to seek prescriptive authority is part of the natural evolution in my continuing efforts to serve underserved and Spanish-speaking communities.  It is borne from personal experience with trauma, as well as from my many work experiences in which I've seen patients wait for extended periods of time, and/or travel over 2 hours, one way, for a psychiatric appointment.  In my current and recent jobs, our institutions have struggled to hire psychiatrists.  However, we could not locate any candidates in over 2 years of active recruitment.  I want to meet these glaring needs.  As Illinois progresses, I look forward to collaborating with colleagues in other states so that prescribing psychologists become a national healthcare standard.'

            "Two of the largest Illinois State Universities (with tens of thousands of undergraduate students) have added undergraduate concentrations in a 'pre-prescribing psychologist' curriculum; and more than 20 hospitals and medical centers, statewide, are working, in collaboration with the Illinois Psychological Association (IPA), to provide medical rotations for the prescribing psychologist trainee.  While organized medicine and psychiatry had vociferously opposed the Illinois bill during the lobbying effort, now that the law has passed, both general medicine and psychiatry have been working hand-in-hand with us to implement the law and accelerate the integration of prescribing psychologists into the healthcare provider network statewide.

            "Under the leadership of prominent healthcare economist, Uwe Reinhardt, scholars at Princeton University's Center for Health and Well-Being have been doing extensive research on the effects of healthcare providers' expanded scope of practice on health status.  An article, soon to published, has been provisionally titled: 'Just What the Nurse Practitioner Ordered: Independent Prescriptive Authority and Population Mental Health.'  One of the stunning preliminary results of this research (looking at mortality data from 1990 to 2013) is that states 'that grant independent prescriptive authority to nurse practitioners experience, on average, a 12% reduction in 'mental-health-related mortality' (including suicides, deaths of unknown intent, and accidental deaths).  The results are more pronounced in areas with a low psychiatrist-to-population ratio and among populations with low levels of education.'  These scholars will also be looking at similar health status data from states that have granted prescriptive authority to psychologists."

            Additional Reflections on the Hoffman Report:  Those attending the Toronto convention had to be impressed by the energy generated surrounding the release of the Hoffman Report.  Very dedicated and sincere colleagues were passionate about their conflicting views of what had transpired and what were the underlying causes/issues.  Accordingly, I subsequently asked a long-time colleague, whom I have tremendous respect for, for his/her perspective.  "Discussions regarding the Hoffman report continue.  In October, four psychologists named in the report issued a response that provided documentation refuting Hoffman's central conclusion, namely, that military psychologists worked to keep ethics guidelines 'loose' in order to enable detainee abuse.  In fact, it appears that the very psychologists under scrutiny assisted in drafting Department of Defense policies designed to prevent detainee abuse.  One such policy, which US Army COL (Ret) Dr. Debra Dunivin helped draft, was itself contained in the Hoffman report supplemental materials and prohibited the very interrogation techniques Mr. Hoffman alleged military psychologists sought to permit.  In November, Division 19, the Society for Military Psychology, issued its own response to the Hoffman report which provided examples of what the Division felt was a deep seated anti-military bias in the report.  APA has yet to respond publicly to the substantive and compelling criticisms of the Hoffman report in either of these documents.  According to The New York Times, Mr. Hoffman has declined to comment on these points.

            "In addition, the Pentagon has brought forth serious concerns about the 2015 APA policy.  It seems that when they voted, many Council members did not realize the 2015 resolution would prevent military psychologists from providing psychological services to detainees.  In a letter to APA, Pentagon officials pointed out that this aspect of the resolution appears to violate Common Article 3 of the Geneva Conventions.  The Pentagon has asked APA to reconsider the blanket prohibition against psychologist involvement in interrogations.  The plan is for APA and DoD representatives to meet soon regarding APA policy and DoD concerns.  It will be critical for both sides to listen to one another carefully in order to craft policies that successfully integrate national security and respect for human rights.  As it moves forward, APA will need to consider how it views the appropriate role of a member association, that is, whether the association's primary focus should be on promoting human rights, or rather on advancing the legitimate interests of all of its members."  "Start Walkin'!"  Aloha,

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

 

Sent from my iPhone