HPA - June column

“ALL YOU NEED IS LOVE”

            I received a most thoughtful invitation from the Association of VA Psychologist Leaders (AVAPL) to participate in their 19^th Annual VA Psychology Leadership Conference in San Antonio, Texas, May 31-June 3, 2016, as they honored their longtime colleague Kathy McNamara who will soon be retiring from federal service.  Appreciation and Love were in the air during the banquet for Kathy.  Over the course of the evening, tributes flowed from APA President Susan McDaniel, APA Senior Advisor for Health Care Financing Randy Phelps, APA lead on Military & Veterans Policy Heather Kelly, and a host of VA psychology leaders including Tom Kirchberg, George Shorter, Lisa Kearny, Rod Baker, Theo Stratis and Russell Lemle.  Theo presented Kathy with a beautiful Pikake lei.  The inscription on Kathy’s gift described her “as persevering, gritty, savvy and as effective an advocate for Veterans and VA psychologists as there’s ever been.”  At the conference Russell received the Patrick DeLeon Advocacy Award.  His tribute to Kathy:

            “Your leadership has been a source of guidance and inspiration for a generation of VA psychologists, of which I clearly count myself.  I first heard of you in 1997 when I approached Christine LaGana with the idea for the AVAPL conference.  Christine (then, lead VA psychologist) spoke with great animation of how you were the voice of VA within APA, and ought to be a key conference organizer.  We first met at the inaugural Dallas gathering.  I observed you closely, and continued to year after year.  While most of us think in terms of individual changes, you demonstrated an uncanny knack for how to change systems.  As VACO officials would finish their conference presentations and the floor was open, you’d stroll up to the mike and wisely engage them about a skillset of psychologists that would improve service to Veterans.  Then you’d fly home, write a while paper and doggedly follow up.

            “You nourished and mentored my budding interest in advocacy.  I’ve lost count of how often I called or wrote over the years.  While I was the Conference Chair, you were the person I would first turn to for big-picture agenda ideas.  Those inquiries morphed into everything VA psychology related.  We both attended all 19 AVAPL conferences.  At the opening cocktail reception, you’d meet me with your warm, beaming smile (belying the fact you’d been flying through the night to get here).  The next morning you’d stroll over to my table with a bag of Kauai shortbread cookies you’d schlepped from home, knowing that my son was a huge fan.  It was typical of your abundant generosity.  Speaking of the conference, you’ve been a core planning committee member for two solid decades.  You did it because you were convinced this conference helped ensure VA Psychology stayed cohesive, strong, proactive, valued.  But of course, that is your way.

            “Your list of accomplishments and acknowledgments is staggering: 25+ years of service on dozens of APA Boards and Committees.  You’re a Fellow in the Academy of Clinical Psychology and five APA Divisions; an ABPP Diplomate; a Distinguished Practitioner in the National Academy of Practice in Psychology; received an APA Presidential Citation and perhaps most impressively, the APA Award for Distinguished Professional Contributions to Institutional Practice.  When we suggested holding this retirement dinner in your honor, your first response was: ‘Oh no, banquets should be reserved for psychologists of much higher stature.’  There is no such category.”

            VA Psychology historian extraordinaire Rod Baker: “In 1989. Rod Torigoe, the chief of psychology at the Honolulu VA Medical Center heard that Kathy had applied for a neuropsychology position at the Tripler Army Medical Center in Honolulu, after discussions with Ray Folen.  Taking that to mean she had an interest in leaving academia and moving to Hawaii, he offered Kathy a staff psychologist position that included training director duties.  With her love of training and work with interns, she accepted and began a VA career that lasts until the present.  In the first days of her appointment she was asked to sign a form that acknowledged she had been given a copy of the staff by-laws.  Unlike many others, though, she read those by-laws first.  She tells the story that she entered Rod’s office in disbelief and asked somewhat testily if he knew what was in the by-laws about psychologists.  She was outraged that psychologists were listed in the by-laws, but only after lab technicians and not as members of the medical staff.  At the end of two and a half years Kathy’s amended by-laws were approved by the medical staff, the psychology service became a full voting member of the executive committee of the medical staff, and psychologists were now credentialed and privileged as licensed and independent providers on the medical staff.

            “Kathy established her role and reputation as an advocate for prescriptive authority and began a campaign with others to convince Division 18’s public service psychologists to support that campaign.  I will note that Division 18’s role in that advocacy produced the most visible role for the division in APA during the last 20 years.  Given her remarkable accomplishments in advocacy for the profession, it is sometime easy to forget Kathy’s work with veterans.  But in summarizing her career chapter in our book, Kathy tells us that what has nurtured her desire to persist in advocacy has been the honor of working with veterans and the interns and residents whose lives have touched hers.  I wish to personally thank you, Kathy, for your service to our veterans and your advocacy for the profession of psychology.”

            Due to the most impressive Texas thunderstorms, I finally arrived as the dinner guests were standing with their drinks in hand.   Clay and I wandered to the bar so I could have my dinner and we were soon joined by Kathy and her admirers.  Lisa Kearney had presented her with a fascinating photo album of her VA days, with awesome memories from former APA President Ron Fox and numerous colleagues.  The next morning I had the opportunity to give my remarks before the 160+ conference attendees.  To thunderous applause: “Kathy it is time for you to run for APA President.  Public service psychology needs you.  Our Veterans, the VA, and rural America need you.  This is not the time to retire.”  That is also my charge for all of the members of the Hawaii Psychological Association.

            What’s Past Can Be Prologue:  HPA came tantalizingly close to enacting RxP this legislative session.  New Mexico’s Elaine LeVine: “Dear Colleagues – My heart goes out to you being so close and then being closed out in this way.  This happened to us in New Mexico.  The bill passed through the House and, then, did not get called up in the Senate, and we knew we had the votes.  Mario and I sat in the chambers until 12:30 at night, until the session closed, hoping.  This is a part of how our democratic system works (or not works?), but from a psychologist’s perspective, words like cowardly and passive aggressive come to mind,  Even so, two very good things have happened.  Getting so close in Hawaii has infused energy in the RxP movement.  And, if New Mexico history is any indication, our bill went through the next year.  Thank you for all your efforts, perseverance, cleverness and passion.  You will prevail and, in the meantime, you have given all of us inspiration that was badly needed.”

Iowa succeeded in May of this year.  Bethe Lonning: “I can remember when I first heard about RxP legislation and folks involved saying that it took about 10 years or so from start to finish, finish meaning passing actual legislation and I thought, ‘Really, 10 years?? That can’t be!’  Well, they were right!  Between working with colleagues who are not sure about adding this to the skills of our profession to actually introducing legislation and going through the process of sub-committee, committees, amendments, more amendments, floor votes (and in our case a vote for re-consideration) and then a Governor’s signature – it is a very long procedure!!!”  Louisiana’s Jim Quillin: “If we don’t quit, we win!”  “All you need is Love.”  Aloha,

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

 

 

 

ALL YOU NEED IS LOVE

   I received a most thoughtful invitation from the Association of VA Psychologist Leaders (AVAPL) to participate in their 19^th Annual VA Psychology Leadership Conference in San Antonio, Texas, May 31-June 3, 2016, as they honored their longtime colleague Kathy McNamara who will soon be retiring from federal service.  Appreciation and Love were in the air during the banquet for Kathy.  Over the course of the evening, tributes flowed from APA President Susan McDaniel, APA Senior Advisor for Health Care Financing Randy Phelps, APA lead on Military & Veterans Policy Heather Kelly, and a host of VA psychology leaders including Tom Kirchberg, George Shorter, Lisa Kearny, Rod Baker, Theo Stratis and Russell Lemle.  Theo presented Kathy with a beautiful Pikake lei.  The inscription on Kathy's gift described her "as persevering, gritty, savvy and as effective an advocate for Veterans and VA psychologists as there's ever been."  At the conference Russell received the Patrick DeLeon Advocacy Award.  His tribute to Kathy:

            "Your leadership has been a source of guidance and inspiration for a generation of VA psychologists, of which I clearly count myself.  I first heard of you in 1997 when I approached Christine LaGana with the idea for the AVAPL conference.  Christine (then, lead VA psychologist) spoke with great animation of how you were the voice of VA within APA, and ought to be a key conference organizer.  We first met at the inaugural Dallas gathering.  I observed you closely, and continued to year after year.  While most of us think in terms of individual changes, you demonstrated an uncanny knack for how to change systems.  As VACO officials would finish their conference presentations and the floor was open, you'd stroll up to the mike and wisely engage them about a skillset of psychologists that would improve service to Veterans.  Then you'd fly home, write a while paper and doggedly follow up.

            "You nourished and mentored my budding interest in advocacy.  I've lost count of how often I called or wrote over the years.  While I was the Conference Chair, you were the person I would first turn to for big-picture agenda ideas.  Those inquiries morphed into everything VA psychology related.  We both attended all 19 AVAPL conferences.  At the opening cocktail reception, you'd meet me with your warm, beaming smile (belying the fact you'd been flying through the night to get here).  The next morning you'd stroll over to my table with a bag of Kauai shortbread cookies you'd schlepped from home, knowing that my son was a huge fan.  It was typical of your abundant generosity.  Speaking of the conference, you've been a core planning committee member for two solid decades.  You did it because you were convinced this conference helped ensure VA Psychology stayed cohesive, strong, proactive, valued.  But of course, that is your way.

            "Your list of accomplishments and acknowledgments is staggering: 25+ years of service on dozens of APA Boards and Committees.  You're a Fellow in the Academy of Clinical Psychology and five APA Divisions; an ABPP Diplomate; a Distinguished Practitioner in the National Academy of Practice in Psychology; received an APA Presidential Citation and perhaps most impressively, the APA Award for Distinguished Professional Contributions to Institutional Practice.  When we suggested holding this retirement dinner in your honor, your first response was: 'Oh no, banquets should be reserved for psychologists of much higher stature.'  There is no such category."

            VA Psychology historian extraordinaire Rod Baker: "In 1989. Rod Torigoe, the chief of psychology at the Honolulu VA Medical Center heard that Kathy had applied for a neuropsychology position at the Tripler Army Medical Center in Honolulu, after discussions with Ray Folen.  Taking that to mean she had an interest in leaving academia and moving to Hawaii, he offered Kathy a staff psychologist position that included training director duties.  With her love of training and work with interns, she accepted and began a VA career that lasts until the present.  In the first days of her appointment she was asked to sign a form that acknowledged she had been given a copy of the staff by-laws.  Unlike many others, though, she read those by-laws first.  She tells the story that she entered Rod's office in disbelief and asked somewhat testily if he knew what was in the by-laws about psychologists.  She was outraged that psychologists were listed in the by-laws, but only after lab technicians and not as members of the medical staff.  At the end of two and a half years Kathy's amended by-laws were approved by the medical staff, the psychology service became a full voting member of the executive committee of the medical staff, and psychologists were now credentialed and privileged as licensed and independent providers on the medical staff.

            "Kathy established her role and reputation as an advocate for prescriptive authority and began a campaign with others to convince Division 18's public service psychologists to support that campaign.  I will note that Division 18's role in that advocacy produced the most visible role for the division in APA during the last 20 years.  Given her remarkable accomplishments in advocacy for the profession, it is sometime easy to forget Kathy's work with veterans.  But in summarizing her career chapter in our book, Kathy tells us that what has nurtured her desire to persist in advocacy has been the honor of working with veterans and the interns and residents whose lives have touched hers.  I wish to personally thank you, Kathy, for your service to our veterans and your advocacy for the profession of psychology."

            Due to the most impressive Texas thunderstorms, I finally arrived as the dinner guests were standing with their drinks in hand.   Clay and I wandered to the bar so I could have my dinner and we were soon joined by Kathy and her admirers.  Lisa Kearney had presented her with a fascinating photo album of her VA days, with awesome memories from former APA President Ron Fox and numerous colleagues.  The next morning I had the opportunity to give my remarks before the 160+ conference attendees.  To thunderous applause: "Kathy it is time for you to run for APA President.  Public service psychology needs you.  Our Veterans, the VA, and rural America need you.  This is not the time to retire."  That is also my charge for all of the members of the Hawaii Psychological Association.

            What's Past Can Be Prologue:  HPA came tantalizingly close to enacting RxP this legislative session.  New Mexico's Elaine LeVine: "Dear Colleagues – My heart goes out to you being so close and then being closed out in this way.  This happened to us in New Mexico.  The bill passed through the House and, then, did not get called up in the Senate, and we knew we had the votes.  Mario and I sat in the chambers until 12:30 at night, until the session closed, hoping.  This is a part of how our democratic system works (or not works?), but from a psychologist's perspective, words like cowardly and passive aggressive come to mind,  Even so, two very good things have happened.  Getting so close in Hawaii has infused energy in the RxP movement.  And, if New Mexico history is any indication, our bill went through the next year.  Thank you for all your efforts, perseverance, cleverness and passion.  You will prevail and, in the meantime, you have given all of us inspiration that was badly needed."

Iowa succeeded in May of this year.  Bethe Lonning: "I can remember when I first heard about RxP legislation and folks involved saying that it took about 10 years or so from start to finish, finish meaning passing actual legislation and I thought, 'Really, 10 years?? That can't be!'  Well, they were right!  Between working with colleagues who are not sure about adding this to the skills of our profession to actually introducing legislation and going through the process of sub-committee, committees, amendments, more amendments, floor votes (and in our case a vote for re-consideration) and then a Governor's signature – it is a very long procedure!!!"  Louisiana's Jim Quillin: "If we don't quit, we win!"  "All you need is Love."  Aloha,

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

 

Sent from my iPhone

IT IS NOT NECESSARY TO CHANGE. SURVIVAL IS NOT MANDATORY

  State Level RxP Successes:  May was a very significant month for those interested in the prescriptive authority (RxP) agenda.  Hawaii was successful in having their legislation pass both the House and Senate; and subsequently the House-Senate conference, although it never made it to the Governor's desk.  Iowa's initial bill passed their Senate by a vote of 28 to 22; the House by 72-22; with the revised bill passing the Senate by a final vote of 33-16.  On May 27, Governor Terry Branstad signed the bill into public law.  This is the fourth state to have enacted RxP legislation with Guam (1998) still in the implementation process.  With the Department of Defense (DoD) and USPHS successfully utilizing the services of prescribing psychologists, those interested in the RxP agenda have been focusing their efforts primarily at the state level, and to some extent within the Department of Veterans Affairs (VA).  The underlying policy issue remains: Should health care practitioners of all disciplines be able to practice to the fullest extent of their training and clinical expertise, as recommended by the Institute of Medicine (IOM) in its landmark 2010 report The Future of Nursing: Leading Change, Advancing Health?  With telehealth/telepsychology increasingly being utilized, why should geographical boundaries continue to play a significant role in defining "quality care"?

            An Exciting Vision for the Future:  Historically, health care "scope of practice" acts have been established and overseen at the state level.  Nevertheless, the federal system (relying upon the constitutional concept of "federal supremacy") has functioned in whatever manner best fulfills its underlying mission.  For example, DoD established the concept of military Medics, made famous by the television show MASH in the early 1970s.  This May, the VA published in the Federal Registerproposed rules for nursing's scope of practice which would essentially override restrictive state barriers which are not in the best interest of clinical and patient care.  During his tenure this effort had the support of former Obama Administration VA Secretary Eric Shinseki (2009-2014).

            "The Department of Veterans Affairs (VA) is proposing to amend its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.  This rulemaking would increase veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians….  VA intends that the services to be provided by an APRN… would be consistent with the nursing profession's standards of practice…."  

            "By permitting APRNs throughout the VHA system a way to achieve full practice authority in order to provide advanced nursing services to the full extent of their professional competence, VHA would further its statutory mandate to provide quality health care to our nation's veterans….  Standardization of APRN full practice authority, without regard for individual State practice regulations, would help to ensure a consistent continuum of health care across VHA by decreasing the variability in APRN practice that currently exists across VHA as a result of disparate State practice regulations.  As of March 7, 2016 CRNAs have full practice authority in 17 states, while CNPs have full practice authority in almost 50% of the nation, which includes 21 states and the District of Columbia….  This proposed rule is consistent with the recommendations of the Institute of Medicine (IOM) of the National Academy of Sciences to remove scope-of-practice barriers.  Specifically, the 2010 IOM report, 'The Future of Nursing: Leading Change, Advancing Health'…."

In this rulemaking, VA is proposing to exercise Federal preemption of State nursing licensure laws to the extent such State laws conflict with the full practice authority granted, except for applicable State restrictions on the authority to prescribe and administer controlled substances.  The VA remains the largest employer of nursing and psychology and, as such, does have a major impact upon the expectations and aspirations of the professions.  Former VA senior official Robert Zeiss reflects: "During my tenure at OAA (2005-2013) and continuing today under the leadership of Kenneth Jones (Director of Associated Health Education), the number of funded psychology postdoctoral training positions increased from 52 to 402.  Phase III of the five year Mental Health Expansion Initiative will increase those numbers even more for the 2015-16 academic year."

            A Historical Perspective:  As indicated, former VA Secretary Eric Shinseki supported this effort.  The key VA architect beyond this evolution was Cathy Rick, former Chief Nursing Officer (2000-2014) and now Senior Advisor for Nursing Leadership at the Jonas Center for Nursing Excellence.  "We began the journey of crafting policy/proposed legislation for APRN full practice in early 2011 with consideration for the following:  * Reduce variability in clinical practice across the entire VA Health Care System.  * Decision for standardization of practice based on solid published evidence/outcomes.  * Consistent with Institute of Medicine recommendations (IOM, 2010).  *Transformation of National Healthcare System.  * Cost-Effective Care.  * Team Based Care/Medical Home/PACT.  And, * Access to Care."  Over the years I have come to appreciate that fundamental change takes time.  Therefore, Cathy's vision, passion, and persistence were absolutely necessary for success.

            Significant Change is Coming:  Also this May, * on a bipartisan vote of 23-3, the Senate Armed Services Committee recommended the enactment of the National Defense Authorization Act for Fiscal Year 2017 which would require, not later than one year after the date of enactment, the commencement of a pilot program to assess the feasibility and advisability of training and utilizing physician assistants (PAs) specializing in psychiatric medication at military medical facilities in order to meet the increasing demand for mental health care by establishing a psychiatric fellowship program for physician assistants.  The pilot program would consist of two rounds with each round taking a maximum of two years to complete.  The Secretary is to select at least five individuals for each round.  And, * at a recent HRSA (Health Resources and Services Administration) Advisory Committee on Interdisciplinary, Community-Based Linkages, Acting Administrator Jim Macrae reported that 30% of new hires in the past two years by federally Qualified Community Health Centers were veterans.   Health centers are our nation's safety net, especially for rural veterans.  One in three people living at or below the poverty level rely upon these centers for their primary medical care.

            In Memory:  Prior to his most unfortunate and totally unexpected passing, former Division 42 President Steve Walfish shared with us the impressive publication by Jeff Zimmerman and Diane Libby Financial Management for your Mental Health Practice: Key Concepts Made Simple.  Throughout his professional career, Steve strove to educate our mental health colleagues on the financial aspects of being a healthcare professional – a critical skill which most of us never learned in graduate school.  Jeff and Diane do a wonderful job of walking their readers through such fundamental concepts as carefully reading official rental agreements and determining appropriate payment rates for practice colleagues.  Who knew that there is so much more to consider in being "an excellent therapist" after those long years of training?  Aloha,

Pat DeLeon, former APA President -- Division 18 – June, 2016

 

Sent from my iPhone

ALOHA -- Division 18 June column

“IT IS NOT NECESSARY TO CHANGE.  SURVIVAL IS NOT MANDATORY”

            State Level RxP Successes:  May was a very significant month for those interested in the prescriptive authority (RxP) agenda.  Hawaii was successful in having their legislation pass both the House and Senate; and subsequently the House-Senate conference, although it never made it to the Governor’s desk.  Iowa’s initial bill passed their Senate by a vote of 28 to 22; the House by 72-22; with the revised bill passing the Senate by a final vote of 33-16.  On May 27, Governor Terry Branstad signed the bill into public law.  This is the fourth state to have enacted RxP legislation with Guam (1998) still in the implementation process.  With the Department of Defense (DoD) and USPHS successfully utilizing the services of prescribing psychologists, those interested in the RxP agenda have been focusing their efforts primarily at the state level, and to some extent within the Department of Veterans Affairs (VA).  The underlying policy issue remains: Should health care practitioners of all disciplines be able to practice to the fullest extent of their training and clinical expertise, as recommended by the Institute of Medicine (IOM) in its landmark 2010 report The Future of Nursing: Leading Change, Advancing Health?  With telehealth/telepsychology increasingly being utilized, why should geographical boundaries continue to play a significant role in defining “quality care”?

            An Exciting Vision for the Future:  Historically, health care “scope of practice” acts have been established and overseen at the state level.  Nevertheless, the federal system (relying upon the constitutional concept of “federal supremacy”) has functioned in whatever manner best fulfills its underlying mission.  For example, DoD established the concept of military Medics, made famous by the television show MASH in the early 1970s.  This May, the VA published in the Federal Register proposed rules for nursing’s scope of practice which would essentially override restrictive state barriers which are not in the best interest of clinical and patient care.  During his tenure this effort had the support of former Obama Administration VA Secretary Eric Shinseki (2009-2014).

            “The Department of Veterans Affairs (VA) is proposing to amend its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.  This rulemaking would increase veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians….  VA intends that the services to be provided by an APRN… would be consistent with the nursing profession’s standards of practice….” 

            “By permitting APRNs throughout the VHA system a way to achieve full practice authority in order to provide advanced nursing services to the full extent of their professional competence, VHA would further its statutory mandate to provide quality health care to our nation’s veterans….  Standardization of APRN full practice authority, without regard for individual State practice regulations, would help to ensure a consistent continuum of health care across VHA by decreasing the variability in APRN practice that currently exists across VHA as a result of disparate State practice regulations.  As of March 7, 2016 CRNAs have full practice authority in 17 states, while CNPs have full practice authority in almost 50% of the nation, which includes 21 states and the District of Columbia….  This proposed rule is consistent with the recommendations of the Institute of Medicine (IOM) of the National Academy of Sciences to remove scope-of-practice barriers.  Specifically, the 2010 IOM report, ‘The Future of Nursing: Leading Change, Advancing Health’….”

In this rulemaking, VA is proposing to exercise Federal preemption of State nursing licensure laws to the extent such State laws conflict with the full practice authority granted, except for applicable State restrictions on the authority to prescribe and administer controlled substances.  The VA remains the largest employer of nursing and psychology and, as such, does have a major impact upon the expectations and aspirations of the professions.  Former VA senior official Robert Zeiss reflects: “During my tenure at OAA (2005-2013) and continuing today under the leadership of Kenneth Jones (Director of Associated Health Education), the number of funded psychology postdoctoral training positions increased from 52 to 402.  Phase III of the five year Mental Health Expansion Initiative will increase those numbers even more for the 2015-16 academic year.”

            A Historical Perspective:  As indicated, former VA Secretary Eric Shinseki supported this effort.  The key VA architect beyond this evolution was Cathy Rick, former Chief Nursing Officer (2000-2014) and now Senior Advisor for Nursing Leadership at the Jonas Center for Nursing Excellence.  “We began the journey of crafting policy/proposed legislation for APRN full practice in early 2011 with consideration for the following:  * Reduce variability in clinical practice across the entire VA Health Care System.  * Decision for standardization of practice based on solid published evidence/outcomes.  * Consistent with Institute of Medicine recommendations (IOM, 2010).  *Transformation of National Healthcare System.  * Cost-Effective Care.  * Team Based Care/Medical Home/PACT.  And, * Access to Care.”  Over the years I have come to appreciate that fundamental change takes time.  Therefore, Cathy’s vision, passion, and persistence were absolutely necessary for success.

            Significant Change is Coming:  Also this May, * on a bipartisan vote of 23-3, the Senate Armed Services Committee recommended the enactment of the National Defense Authorization Act for Fiscal Year 2017 which would require, not later than one year after the date of enactment, the commencement of a pilot program to assess the feasibility and advisability of training and utilizing physician assistants (PAs) specializing in psychiatric medication at military medical facilities in order to meet the increasing demand for mental health care by establishing a psychiatric fellowship program for physician assistants.  The pilot program would consist of two rounds with each round taking a maximum of two years to complete.  The Secretary is to select at least five individuals for each round.  And, * at a recent HRSA (Health Resources and Services Administration) Advisory Committee on Interdisciplinary, Community-Based Linkages, Acting Administrator Jim Macrae reported that 30% of new hires in the past two years by federally Qualified Community Health Centers were veterans.   Health centers are our nation’s safety net, especially for rural veterans.  One in three people living at or below the poverty level rely upon these centers for their primary medical care.

            In Memory:  Prior to his most unfortunate and totally unexpected passing, former Division 42 President Steve Walfish shared with us the impressive publication by Jeff Zimmerman and Diane Libby Financial Management for your Mental Health Practice: Key Concepts Made Simple.  Throughout his professional career, Steve strove to educate our mental health colleagues on the financial aspects of being a healthcare professional – a critical skill which most of us never learned in graduate school.  Jeff and Diane do a wonderful job of walking their readers through such fundamental concepts as carefully reading official rental agreements and determining appropriate payment rates for practice colleagues.  Who knew that there is so much more to consider in being “an excellent therapist” after those long years of training?  Aloha,

Pat DeLeon, former APA President -- Division 18 – June, 2016

 

THE BEAT GOES ON

Slow But Steady Progress At The State Level:  The 1992 APA Task Force Report for the Council of Representatives, chaired by Michael Smyer, concluded that: "Practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge.  The contributions of this new form of psychopharmacological intervention has the potential to improve dramatically patient care and make important new advances in treatment."  The Department of Defense (DoD) and U.S. Public Health Service have embraced these new practitioners, appropriately modifying their clinical regulations.  Bob McGrath, one of the visionary architects of psychology's civilian RxP training initiatives, estimates that currently there are at least 1,750 graduates of these programs.  For those interested in history, in August, 1995 the APA Council of Representatives formally endorsed prescriptive authority for appropriately trained psychologists as APA policy.

In March, 2002 New Mexico enacted the first state-initiated prescriptive authority (RxP) legislation; followed by Louisiana in May, 2004, with John Bolter writing the first civilian script on January 20, 2005.  Nearly a decade later, in June, 2014 Illinois passed their legislation, with Beth Rom-Rymer reporting that there are currently over 135 psychologists in-training to become prescribing psychologists.  Few psychologists appreciate that back in March, 1993 Indiana enacted legislation which, when finally implemented, will authorize RxP.  Similarly, Guam enacted their RxP legislation in December, 1998.  Although Guam's regulations were promulgated in March, 2012, the lack of support from psychiatry has apparently made it quite difficult for any psychologist seeking to be credentialed.  One might surmise that ultimately the courts may need to become involved, pursuant to the 2014 U.S. Supreme Court holding regarding the North Carolina State Board of Dental Examiners, in order to address potential anti-competitive activities.

Significantly Renewed Activity in 2016:  Exciting efforts occurred this legislative cycle on the RxP agenda in Iowa and Hawaii.  An earlier Hawaii effort had been vetoed by their Governor nearly a decade ago.  Iowa's Elizabeth Lonning: "Our legislation was passed by the Senate in early April, 28 to 22.  This was after it was voted down earlier in the session and 'a motion to reconsider' was filed by our bill mover, Senator Joe Bolkcam at that time.  So, we spent several weeks visiting at the Capitol to speak to Senators about the possibility of changing their votes.  The House indicated they would not take action on the legislation until the Senate finished their action.  We were successful in getting several Senators to understand our legislation more thoroughly and the vote passed 28-22 as indicated, on April 6^th.

"We then started working on the House and while we were placed on the schedule, due to budget issues and our session winding down, we kept getting pushed to the following day.  The opposition was quite strong with House members and our bill mover in the House, Rep. Linda Miller, called a meeting with both sides and highly encouraged cooperation.  So, a final amendment as drafted on Monday, April 25^th outlining that the Board of Psychology and the Board of Medicine would work together in the administrative rules process, as well as working together with the doctoral psychology programs in the state and the University of Iowa Medical College on a training program.  This amendment changed the opposition's position from 'opposed' to 'neutral.'  That allowed the House vote to be 72-22 in our favor.  Because the amendment was not part of the Senate version, the Senate then voted on the amended legislation on Wednesday, the 27^th of April and it passed again 33-16.  It is now on its way to the Governor.  We are hopeful to schedule a meeting with his office next week."  [April 30, 2016].          Hawaii's Jill Oliveira Gray: "The 2016 Hawai'i RxP initiative was nothing short of exciting with a tremendous amount of activity across multiple sectors – community, grassroots, consumers, organizations, and professionals.  The significant progress made this year was the most made in nine years, since the bill passed the Hawai'i legislature in 2007.  Many individuals worked tirelessly to move HB 1072 through this legislative session.  Front and center was an extraordinary consumer advocate from Maui, Don Lane, who courageously and poetically brought his personal story to the attention of Hawai'i legislators and to the public.  Don is also a Media Specialist at Mental Health Kokua and created a documentary called 'Haleakala: A Trek for Dignity,' to raise awareness of mental illness and end stigma and prejudice associated with having mental illness.  Don's documentary was broadcasted on PBS Hawai'i (http://pbshawaii.org/insights-on-pbs-hawaii-title-pending/) and was followed by an in-depth discussion with Don and other mental health advocates and local resources talking about how to improve access to care and promote mental health well-being.  Don and other consumer advocates continued to work fearlessly throughout the session to educate legislators about their personal struggle to obtain sufficient psychiatric care in their communities.  Their voices have definitely had an impact.

            "Hawai'i Psychological Association (HPA) has been fortunate to maintain Lobbyist Alex Santiago who continues to bring forth his considerable legislative experience and commitment to advance RxP in Hawai'i.  Ray Folen, a seasoned and longtime RxP advocate, recently assumed the role of HPA's Executive Director.  HPA's new Legislative Committee chair, Julie Takishima-Lacasa, did a stellar job in re-energizing HPA's Legislative Committee this year and put additional tireless effort into the RxP initiative as well.  I continue to lead the HPA RxP Committee, working very closely with champion legislators, the Department of Health and Board of Psychology to improve on the bill language from last session with language mutually agreed upon and believed to be necessary and relevant for Hawai'i.  Having this collaboration from the beginning of the session helped to demonstrate a higher level of support for, and investment in, HB 1072.

            "Kelly Doty Harnick also serves as the Neighbor Island RxP Chair.  Kelly and Don actually started their grassroots efforts in 2014 and continue to build an even stronger community coalition on Maui.  Kelly was instrumental in developing our social media presence https://www.facebook.com/RxPHawaii/?fref=ts and website http://www.rxphawaii.com/, both of which serve as excellent informational hubs and forums for Hawai'i's RxP efforts.  The Hawai'i RxP petition, started by Don Lane, can be found on our website and now includes over 1,000 signatures of support.

            "Judi Steinman, Program Director for the University of Hawai'i at Hilo, Daniel K. Inouye College of Pharmacy, Master of Science in Clinical Psychopharmacology (MSCP) Program was incredible and steadfast in dispelling myths about the rigor of the psychopharmacology training program.  She, along with other psychologists such as Marie Terry-Bivens (HPA Past President) and Nicole Robello (current student in the MSCP program) were influential in rallying major community, consumer, and legislator support from neighbor islands such as Kauai, Moloka'i, and Hawai'i island.  Hundreds of other supporters were pivotal in our success this session, including our colleagues from APA, APAPO and Division 55.  We are so grateful for all the wisdom, guidance, energy, and support we received.

            "Despite the significant progress this legislative session to include HB 1072 passing through two Senate hearings, two Senate floor votes (passed third reading with 22 ayes, 2 noe's, 1 excused and final reading with 22 ayes and 3 noes), and an extended conference committee period, and, unprecedented support from the Department of Health and the Board of Psychology, in the final reading the House used a very controversial procedural rule to kill the bill in spite of our belief that a majority of members supported it.  A concerted effort was made by RxP advocates to implore on House leadership to resurrect the bill and have it receive a fair floor vote on the last day of the session, unfortunately, this did not happen.  Devastated but not beaten, Hawai'i's RxP warriors will come back next legislative session stronger than ever and continue to stand up for access to care and prescriptive authority for psychologists."

            New Mexico's Elaine LeVine: "Dear Colleagues – My heart goes out to you being so close and then being closed out in this way.  This happened to us in New Mexico.  The bill passed through the House and, then, did not get called up in the Senate, and we knew we had the votes.  Mario and I sat in the chambers until 12:30 at night, until the session closed, hoping.  This is a part of how our democratic system works (or not works?), but from a psychologist's perspective, words like cowardly and passive aggressive come to mind,  Even so, two very good things have happened.  Getting so close in Hawaii has infused energy in the RxP movement.  And, if New Mexico history is any indication, our bill went through the next year.  Thank you for all your efforts, perseverance, cleverness and passion.  You will prevail and, in the meantime, you have given all of us inspiration that was badly needed."  The Beat Goes On.  Aloha,

Pat DeLeon, former APA President – Division 42 – May, 2016

 

Sent from my iPhone

ALOHA - Division 42 column

THE BEAT GOES ON

            Slow But Steady Progress At The State Level:  The 1992 APA Task Force Report for the Council of Representatives, chaired by Michael Smyer, concluded that: “Practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge.  The contributions of this new form of psychopharmacological intervention has the potential to improve dramatically patient care and make important new advances in treatment.”  The Department of Defense (DoD) and U.S. Public Health Service have embraced these new practitioners, appropriately modifying their clinical regulations.  Bob McGrath, one of the visionary architects of psychology’s civilian RxP training initiatives, estimates that currently there are at least 1,750 graduates of these programs.  For those interested in history, in August, 1995 the APA Council of Representatives formally endorsed prescriptive authority for appropriately trained psychologists as APA policy.

In March, 2002 New Mexico enacted the first state-initiated prescriptive authority (RxP) legislation; followed by Louisiana in May, 2004, with John Bolter writing the first civilian script on January 20, 2005.  Nearly a decade later, in June, 2014 Illinois passed their legislation, with Beth Rom-Rymer reporting that there are currently over 135 psychologists in-training to become prescribing psychologists.  Few psychologists appreciate that back in March, 1993 Indiana enacted legislation which, when finally implemented, will authorize RxP.  Similarly, Guam enacted their RxP legislation in December, 1998.  Although Guam’s regulations were promulgated in March, 2012, the lack of support from psychiatry has apparently made it quite difficult for any psychologist seeking to be credentialed.  One might surmise that ultimately the courts may need to become involved, pursuant to the 2014 U.S. Supreme Court holding regarding the North Carolina State Board of Dental Examiners, in order to address potential anti-competitive activities.

Significantly Renewed Activity in 2016:  Exciting efforts occurred this legislative cycle on the RxP agenda in Iowa and Hawaii.  An earlier Hawaii effort had been vetoed by their Governor nearly a decade ago.  Iowa’s Elizabeth Lonning: “Our legislation was passed by the Senate in early April, 28 to 22.  This was after it was voted down earlier in the session and ‘a motion to reconsider’ was filed by our bill mover, Senator Joe Bolkcam at that time.  So, we spent several weeks visiting at the Capitol to speak to Senators about the possibility of changing their votes.  The House indicated they would not take action on the legislation until the Senate finished their action.  We were successful in getting several Senators to understand our legislation more thoroughly and the vote passed 28-22 as indicated, on April 6^th.

“We then started working on the House and while we were placed on the schedule, due to budget issues and our session winding down, we kept getting pushed to the following day.  The opposition was quite strong with House members and our bill mover in the House, Rep. Linda Miller, called a meeting with both sides and highly encouraged cooperation.  So, a final amendment as drafted on Monday, April 25^th outlining that the Board of Psychology and the Board of Medicine would work together in the administrative rules process, as well as working together with the doctoral psychology programs in the state and the University of Iowa Medical College on a training program.  This amendment changed the opposition’s position from ‘opposed’ to ‘neutral.’  That allowed the House vote to be 72-22 in our favor.  Because the amendment was not part of the Senate version, the Senate then voted on the amended legislation on Wednesday, the 27^th of April and it passed again 33-16.  It is now on its way to the Governor.  We are hopeful to schedule a meeting with his office next week.”  [April 30, 2016].          Hawaii’s Jill Oliveira Gray: “The 2016 Hawai’i RxP initiative was nothing short of exciting with a tremendous amount of activity across multiple sectors – community, grassroots, consumers, organizations, and professionals.  The significant progress made this year was the most made in nine years, since the bill passed the Hawai’i legislature in 2007.  Many individuals worked tirelessly to move HB 1072 through this legislative session.  Front and center was an extraordinary consumer advocate from Maui, Don Lane, who courageously and poetically brought his personal story to the attention of Hawai’i legislators and to the public.  Don is also a Media Specialist at Mental Health Kokua and created a documentary called ‘Haleakala: A Trek for Dignity,’ to raise awareness of mental illness and end stigma and prejudice associated with having mental illness.  Don’s documentary was broadcasted on PBS Hawai’i (http://pbshawaii.org/insights-on-pbs-hawaii-title-pending/) and was followed by an in-depth discussion with Don and other mental health advocates and local resources talking about how to improve access to care and promote mental health well-being.  Don and other consumer advocates continued to work fearlessly throughout the session to educate legislators about their personal struggle to obtain sufficient psychiatric care in their communities.  Their voices have definitely had an impact.

            “Hawai’i Psychological Association (HPA) has been fortunate to maintain Lobbyist Alex Santiago who continues to bring forth his considerable legislative experience and commitment to advance RxP in Hawai’i.  Ray Folen, a seasoned and longtime RxP advocate, recently assumed the role of HPA’s Executive Director.  HPA’s new Legislative Committee chair, Julie Takishima-Lacasa, did a stellar job in re-energizing HPA’s Legislative Committee this year and put additional tireless effort into the RxP initiative as well.  I continue to lead the HPA RxP Committee, working very closely with champion legislators, the Department of Health and Board of Psychology to improve on the bill language from last session with language mutually agreed upon and believed to be necessary and relevant for Hawai’i.  Having this collaboration from the beginning of the session helped to demonstrate a higher level of support for, and investment in, HB 1072.

            “Kelly Doty Harnick also serves as the Neighbor Island RxP Chair.  Kelly and Don actually started their grassroots efforts in 2014 and continue to build an even stronger community coalition on Maui.  Kelly was instrumental in developing our social media presence https://www.facebook.com/RxPHawaii/?fref=ts and website http://www.rxphawaii.com/, both of which serve as excellent informational hubs and forums for Hawai’i’s RxP efforts.  The Hawai’i RxP petition, started by Don Lane, can be found on our website and now includes over 1,000 signatures of support.

            “Judi Steinman, Program Director for the University of Hawai’i at Hilo, Daniel K. Inouye College of Pharmacy, Master of Science in Clinical Psychopharmacology (MSCP) Program was incredible and steadfast in dispelling myths about the rigor of the psychopharmacology training program.  She, along with other psychologists such as Marie Terry-Bivens (HPA Past President) and Nicole Robello (current student in the MSCP program) were influential in rallying major community, consumer, and legislator support from neighbor islands such as Kauai, Moloka’i, and Hawai’i island.  Hundreds of other supporters were pivotal in our success this session, including our colleagues from APA, APAPO and Division 55.  We are so grateful for all the wisdom, guidance, energy, and support we received.

            “Despite the significant progress this legislative session to include HB 1072 passing through two Senate hearings, two Senate floor votes (passed third reading with 22 ayes, 2 noe’s, 1 excused and final reading with 22 ayes and 3 noes), and an extended conference committee period, and, unprecedented support from the Department of Health and the Board of Psychology, in the final reading the House used a very controversial procedural rule to kill the bill in spite of our belief that a majority of members supported it.  A concerted effort was made by RxP advocates to implore on House leadership to resurrect the bill and have it receive a fair floor vote on the last day of the session, unfortunately, this did not happen.  Devastated but not beaten, Hawai’i’s RxP warriors will come back next legislative session stronger than ever and continue to stand up for access to care and prescriptive authority for psychologists.”

            New Mexico’s Elaine LeVine: “Dear Colleagues – My heart goes out to you being so close and then being closed out in this way.  This happened to us in New Mexico.  The bill passed through the House and, then, did not get called up in the Senate, and we knew we had the votes.  Mario and I sat in the chambers until 12:30 at night, until the session closed, hoping.  This is a part of how our democratic system works (or not works?), but from a psychologist’s perspective, words like cowardly and passive aggressive come to mind,  Even so, two very good things have happened.  Getting so close in Hawaii has infused energy in the RxP movement.  And, if New Mexico history is any indication, our bill went through the next year.  Thank you for all your efforts, perseverance, cleverness and passion.  You will prevail and, in the meantime, you have given all of us inspiration that was badly needed.”  The Beat Goes On.  Aloha,

Pat DeLeon, former APA President – Division 42 – May, 2016