“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 70th 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
