AN ERA OF TRANSFORMATION, PERHAPS

 It might be a fair observation – although open for debate – that those intimately involved in the field of psychology and more recently mental health/behavioral health have been relatively unaffected by the swings in the political/public policy gestalt, as reflected by the media, over the past several decades.  Thanks to the efforts of APA and APS, those in academia have become increasingly successful in obtaining additional research funding and those in practice have found expanding markets for their services.  As the profession has matured, more colleagues have obtained positions of administrative responsibility and have become increasingly involved in the legislative process, including serving as Governor and in the U.S. House of Representatives.  One should, of course, recall that John W. Gardner served as Secretary of the Department of Health, Education, and Welfare (HEW) under President Lyndon Johnson during the Great Society era, prior to becoming President of Common Cause.  There are increasing signs, however, that this relatively protective state of invisibility might be changing, especially as technology has become more integrated into our nation's health care environment.

On July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198).  This bipartisan legislation was crafted to "address the national epidemics of prescription opioid abuse and heroin use."  The USPHS Surgeon General: "Nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C."  Included within this legislation is a provision which establishes a special Commission to examine the evidence-based therapy treatment model used by the Department of Veterans Affairs (VA) for treating mental health conditions of veterans and the potential benefits of incorporating complementary (CAM) and integrative health as standard practice throughout the Department.

This is at a time when the VA indicates that, after examining over 55 million records, in 2014 the number of veteran deaths by suicide averaged 20 per day.  To put this staggering figure in perspective; since 2001, the nation's adult civilian suicide rate increased 23%, while veteran suicides increased 32% during the same time period.  After controlling for age and gender, the risk of suicide for veterans was 21% higher than for non-veterans.  Most members of APA are not aware that although VA is the largest employer of psychologists, APA does not have an office of Veterans or Military Affairs, even though one in 10 adults is a veteran and one in 6 Americans is either a military service member, veteran, or their dependent.

            The legislatively created Commission will: (1) examine the efficacy of the evidence-based therapy model used by VA to treat mental health illnesses and identify areas of improvement; (2) conduct a patient-centered survey within each VISN (Veterans Integrated Service Network) to examine: the experiences of veterans with VA and non-VA facilities regarding mental health care, the preferences of veterans and which methods they believe to be most effective; the experience, if any, of veterans with respect to the complementary and integrative health treatment therapies, the prevalence of prescribing medication to veterans seeking treatment for mental health disorders through VA, and the outreach efforts of VA regarding the availability of benefits and treatments for veterans for addressing mental health issues; (3) examine available research on complementary and integrative health for mental health disorders in areas of therapy including: music therapy, equine therapy, service dogs, yoga therapy, acupuncture therapy, meditation therapy, outdoor sports therapy, hyperbaric oxygen therapy, accelerated resolution therapy, art therapy, magnetic resonance therapy, and others; (4) study the sufficiency of VA resources to deliver quality mental health care; and (5) study the current treatments and resources available within VA, as well as assess the effectiveness of such treatments and resources in decreasing the number of suicides per day by veterans, the number of veterans who have been diagnosed with mental health issues, the percentage of veterans who have completed VA counseling sessions, and the efforts of VA to expand complementary and integrative health treatments viable to the recovery of veterans with mental health issues as determined by the Secretary to improve the effectiveness of treatments offered by VA.  The law further requires the Secretary, when informed by the Commission's findings, to commence a pilot program to assess the feasibility and advisability of using wellness-based programs to complement pain management and related health care services.

            Do Commissions make a difference?  In our experience, they do.  P.L.113-146, the Veterans Access, Choice, and Accountability Act of 2014, established the Commission on Care to review a requested comprehensive independent assessment of VHA (Veterans Health Agency) care delivery and management systems, examine access to care, and look more expansively at how veterans' care should be organized and delivered during the next two decades.  This Commission held 26 days of public meetings receiving testimony from a broad range of experts and stakeholders and conducted site visits to VHA facilities.  The Commission's conclusions: "The next 20 years will see continued dynamic change in health care, well beyond the Commission's capacity to forecast the future.  What is clear, though, is that the concept of access to care is itself undergoing marked change.  The potentially explosive growth of telemedicine, increasing emphasis on preventive care, and likely proliferation of technologies that permit routine home-based health monitoring and care of patients with chronic illnesses will dramatically affect access needs.  We are also witnessing profound changes in the nature of patient-provider engagement and in where and how care is delivered.  VHA must keep pace with, and even be a leader in, these changes…."

            "The Commission's report underscores the importance of transforming VA health care delivery and the systems that underlie it….  (C)hange that requires new direction, new investment, and profound reengineering.  Some will question that view, and perhaps challenge the notion that the nation should invest further in the VA health care system.  None, however, should question the nation's obligation to those who sustained injury or illness in service, or who are at increased health risk as a result of deployments to combat zones or other service-related experiences…."

            "(T)he Commission recognizes the VA health care system has valuable strengths, including some unique and exceptional clinical programs and services tailored to the needs of the millions of veterans who turn to VA for care.  For example, VHA's behavioral health programs, particularly with their integration of behavioral health and primary-care [which was a high priority for Toni Zeiss as the VA's chief consultant for mental health], are largely unrivalled, and profoundly important to many who have suffered from the effects of battle and for whom VHA is a safety net….  Transformation is a difficult process that will require careful stewardship, sustainable leadership, and unwavering focus and commitment to the long-term vision and strategy….  Our nation's veterans deserve no less."

            Those colleagues who have been working with the military will especially appreciate the Commission's sensitivity to their unique environment.  "In addition to addressing the needs of minority veterans and vulnerable veterans populations, VA must address military-specific needs and ensure that all providers in the VHA Care System have sufficient military competency (i.e., knowledge of specific issues and health care needs of those who served in the military)….  Health care disparities often result from patients' lack of trust in their health care provider; therefore, enhancing the patient-provider relationship is paramount in overcoming these disparities.  Stereotypical thinking on the part of the providers about certain patient groups, including veterans, may unwittingly influence their prognosis."

Specific reasons for the increase of health care disparities within the military population include the following: * The cultural norms of the military are such that to admit or display any signs of perceived weakness, especially related to mental health issues, discourages military personnel and veterans from seeking medical care and treatment.  * Changes in the demographical makeup of the civilian population result in similar changes to the military population.  * A small but gradual increase in the number of foreign born personnel who have joined the ranks of the military.  * And, A disengaged provider culture that may have become more immersed in the medical culture than the military culture.  "VA must make cultural and military competence a strategic priority…."  The Commission further noted that women are the fastest growing group within the veteran population.  As of 2011, approximately 1.8 million (8%) of the 22.2 million veterans were women.  By 2020, women veterans will comprise nearly 11% of the total veteran population.

This summer the VA proposed to amend its regulations to permit full practice authority for its Advanced Practice Registered Nurses (APRNs) relying upon its federal supremacy authority.  By the close of the public commentary period, an extraordinary 223,000 comments had been received, with approximately 60% supportive.  This modification would essentially establish national licensure for APRNs.  Who is next?  Change is definitely in the future.  Aloha,

Pat DeLeon, former APA President – Division One – September, 2016

 

Sent from my iPhone

Aloha - Division One column

AN ERA OF TRANSFORMATION, PERHAPS

            It might be a fair observation – although open for debate – that those intimately involved in the field of psychology and more recently mental health/behavioral health have been relatively unaffected by the swings in the political/public policy gestalt, as reflected by the media, over the past several decades.  Thanks to the efforts of APA and APS, those in academia have become increasingly successful in obtaining additional research funding and those in practice have found expanding markets for their services.  As the profession has matured, more colleagues have obtained positions of administrative responsibility and have become increasingly involved in the legislative process, including serving as Governor and in the U.S. House of Representatives.  One should, of course, recall that John W. Gardner served as Secretary of the Department of Health, Education, and Welfare (HEW) under President Lyndon Johnson during the Great Society era, prior to becoming President of Common Cause.  There are increasing signs, however, that this relatively protective state of invisibility might be changing, especially as technology has become more integrated into our nation’s health care environment.

On July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198).  This bipartisan legislation was crafted to “address the national epidemics of prescription opioid abuse and heroin use.”  The USPHS Surgeon General: “Nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.”  Included within this legislation is a provision which establishes a special Commission to examine the evidence-based therapy treatment model used by the Department of Veterans Affairs (VA) for treating mental health conditions of veterans and the potential benefits of incorporating complementary (CAM) and integrative health as standard practice throughout the Department.

This is at a time when the VA indicates that, after examining over 55 million records, in 2014 the number of veteran deaths by suicide averaged 20 per day.  To put this staggering figure in perspective; since 2001, the nation’s adult civilian suicide rate increased 23%, while veteran suicides increased 32% during the same time period.  After controlling for age and gender, the risk of suicide for veterans was 21% higher than for non-veterans.  Most members of APA are not aware that although VA is the largest employer of psychologists, APA does not have an office of Veterans or Military Affairs, even though one in 10 adults is a veteran and one in 6 Americans is either a military service member, veteran, or their dependent.

            The legislatively created Commission will: (1) examine the efficacy of the evidence-based therapy model used by VA to treat mental health illnesses and identify areas of improvement; (2) conduct a patient-centered survey within each VISN (Veterans Integrated Service Network) to examine: the experiences of veterans with VA and non-VA facilities regarding mental health care, the preferences of veterans and which methods they believe to be most effective; the experience, if any, of veterans with respect to the complementary and integrative health treatment therapies, the prevalence of prescribing medication to veterans seeking treatment for mental health disorders through VA, and the outreach efforts of VA regarding the availability of benefits and treatments for veterans for addressing mental health issues; (3) examine available research on complementary and integrative health for mental health disorders in areas of therapy including: music therapy, equine therapy, service dogs, yoga therapy, acupuncture therapy, meditation therapy, outdoor sports therapy, hyperbaric oxygen therapy, accelerated resolution therapy, art therapy, magnetic resonance therapy, and others; (4) study the sufficiency of VA resources to deliver quality mental health care; and (5) study the current treatments and resources available within VA, as well as assess the effectiveness of such treatments and resources in decreasing the number of suicides per day by veterans, the number of veterans who have been diagnosed with mental health issues, the percentage of veterans who have completed VA counseling sessions, and the efforts of VA to expand complementary and integrative health treatments viable to the recovery of veterans with mental health issues as determined by the Secretary to improve the effectiveness of treatments offered by VA.  The law further requires the Secretary, when informed by the Commission’s findings, to commence a pilot program to assess the feasibility and advisability of using wellness-based programs to complement pain management and related health care services.

            Do Commissions make a difference?  In our experience, they do.  P.L.113-146, the Veterans Access, Choice, and Accountability Act of 2014, established the Commission on Care to review a requested comprehensive independent assessment of VHA (Veterans Health Agency) care delivery and management systems, examine access to care, and look more expansively at how veterans’ care should be organized and delivered during the next two decades.  This Commission held 26 days of public meetings receiving testimony from a broad range of experts and stakeholders and conducted site visits to VHA facilities.  The Commission’s conclusions: “The next 20 years will see continued dynamic change in health care, well beyond the Commission’s capacity to forecast the future.  What is clear, though, is that the concept of access to care is itself undergoing marked change.  The potentially explosive growth of telemedicine, increasing emphasis on preventive care, and likely proliferation of technologies that permit routine home-based health monitoring and care of patients with chronic illnesses will dramatically affect access needs.  We are also witnessing profound changes in the nature of patient-provider engagement and in where and how care is delivered.  VHA must keep pace with, and even be a leader in, these changes….”

            “The Commission’s report underscores the importance of transforming VA health care delivery and the systems that underlie it….  (C)hange that requires new direction, new investment, and profound reengineering.  Some will question that view, and perhaps challenge the notion that the nation should invest further in the VA health care system.  None, however, should question the nation’s obligation to those who sustained injury or illness in service, or who are at increased health risk as a result of deployments to combat zones or other service-related experiences….”

            “(T)he Commission recognizes the VA health care system has valuable strengths, including some unique and exceptional clinical programs and services tailored to the needs of the millions of veterans who turn to VA for care.  For example, VHA’s behavioral health programs, particularly with their integration of behavioral health and primary-care [which was a high priority for Toni Zeiss as the VA’s chief consultant for mental health], are largely unrivalled, and profoundly important to many who have suffered from the effects of battle and for whom VHA is a safety net….  Transformation is a difficult process that will require careful stewardship, sustainable leadership, and unwavering focus and commitment to the long-term vision and strategy….  Our nation’s veterans deserve no less.”

            Those colleagues who have been working with the military will especially appreciate the Commission’s sensitivity to their unique environment.  “In addition to addressing the needs of minority veterans and vulnerable veterans populations, VA must address military-specific needs and ensure that all providers in the VHA Care System have sufficient military competency (i.e., knowledge of specific issues and health care needs of those who served in the military)….  Health care disparities often result from patients’ lack of trust in their health care provider; therefore, enhancing the patient-provider relationship is paramount in overcoming these disparities.  Stereotypical thinking on the part of the providers about certain patient groups, including veterans, may unwittingly influence their prognosis.”

Specific reasons for the increase of health care disparities within the military population include the following: * The cultural norms of the military are such that to admit or display any signs of perceived weakness, especially related to mental health issues, discourages military personnel and veterans from seeking medical care and treatment.  * Changes in the demographical makeup of the civilian population result in similar changes to the military population.  * A small but gradual increase in the number of foreign born personnel who have joined the ranks of the military.  * And, A disengaged provider culture that may have become more immersed in the medical culture than the military culture.  “VA must make cultural and military competence a strategic priority….”  The Commission further noted that women are the fastest growing group within the veteran population.  As of 2011, approximately 1.8 million (8%) of the 22.2 million veterans were women.  By 2020, women veterans will comprise nearly 11% of the total veteran population.

This summer the VA proposed to amend its regulations to permit full practice authority for its Advanced Practice Registered Nurses (APRNs) relying upon its federal supremacy authority.  By the close of the public commentary period, an extraordinary 223,000 comments had been received, with approximately 60% supportive.  This modification would essentially establish national licensure for APRNs.  Who is next?  Change is definitely in the future.  Aloha,

Pat DeLeon, former APA President – Division One – September, 2016

 

TIME FOR DOD AND VA TO TRULY COLLABORATE ?

P.L. 114-198:  One of the most exciting aspects of being involved in the public policy/political process is the opportunity to sense the future evolving in unexpected venues.  On July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198).  This bipartisan legislation was crafted to "address the national epidemics of prescription opioid abuse and heroin use."  The USPHS Surgeon General: "Nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C."  The legislation addresses a number of issues which should be of direct interest to military psychologists and your colleagues throughout the public sector, especially those within the VA.  Two underlying themes: * Developing collaborative relationships with the VA and * Ensuring provider accountability, including requiring reports from state medical boards on adverse licensure actions for new hires (Section 941).

            Section 912 requires VA and DoD to ensure that the Health Executive Committee's Pain Management Working Group (PMWG) includes a focus on the opioid prescribing practices of health care providers of each Department; the ability of each Department to manage acute and chronic pain, including training health care providers with respect to pain management; the use of complementary and integrative health (CAM); the concurrent use by health care providers of opioids and prescription drugs to treat mental health disorders, including benzodiazepines; the use of care transition plans by health care providers to address case management issues for patients receiving opioid therapy who transition between inpatient and outpatient settings; coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from DOD to VA; and the ability to screen, identify, and treat patients with substance use disorders who are seeking treatment for acute and chronic pain.  The law further requires VA and DOD to jointly update the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain within 180 days of enactment.

Section 921 requires that, within 90 days of enactment, and quarterly thereafter, each VA medical facility will host a public community meeting on improving VA health care; and within one year, and at least annually thereafter, that each community-based outpatient clinic shall host such a community meeting.  These meetings will require regular senior leadership attendance and notice will be given to the House and Senate Veterans Affairs Committees, as well as the Members of Congress representing that area.

Section 931 establishes a Commission to examine the evidence-based therapy treatment model used by the VA for treating mental health conditions of veterans and the potential benefits of incorporating CAM as standard practice throughout the Department.   The Commission is to examine the efficacy of the evidence-based therapy model used by the VA and identify areas of improvement.  It will conduct a patient-centered survey within each VISN to examine the experiences of veterans with VA facilities and non-VA facilities and their preferences.  It will also study the prevalence of prescribing medications for those seeking mental health treatment and the research on CAM, including service dogs, acupuncture, yoga, etc.

Section 105 would award demonstration grants to states to streamline the licensure requirements for veterans who held military occupational specialties related to medical care or who completed certain military medical training to more easily meet civilian health care licensure requirements.   Many should be expected to ultimately work within the public sector, particularly within the VA or our nation's network of Federally Qualified Community Health Centers (FQHCs) which report that 30% of their new hires in the past 2 years were veterans.

APA's Denver Convention:  The APA Council of Representatives voted to adopt as policythe Resolution on Psychologists in Integrated Primary Care and Specialty Health Settings.  The resolution aims to encourage APA policies and initiatives that advance evidence-based, interprofessional approaches to patient and family health.  "Primary care is considered the 'de facto' mental health system where at least 60% of medical visits have psychosocial components; approximately 20% of primary care patients meet criteria for a diagnosis of depression, and roughly 15% have generalized anxiety; depression, anxiety, obesity and smoking are frequently initially treated in primary care settings in adult patients; and attention deficit disorder in typically treated in pediatric primary care."  "Access to psychological services through the [VA] and [DoD] healthcare systems allows for primary care settings to provide behavioral healthcare to veterans, active duty and retired service men and women and their families."  And, "Psychologists across the United States increasingly serve in leadership roles…."  Within both Departments, psychologists have been on the cutting-edge of these critical developments.  Col. Becky Porter recently retired as Director of the DiLorenzo TRICARE Health Clinic at the Pentagon, and an Army nurse, Col. Amal Chatila, has now assumed command.  With vision and collaboration, the future is very bright.

The VA is the largest employer of psychologists.  In Denver it was noted that most members are not aware that APA does not have an office of Veterans or Military Affairs, even though one in 10 adults is a Veteran and one in 6 Americans is either a military service member, Veteran, or their dependent.  Division 19, collaborating with VA colleagues, should take the lead in rectifying this unfortunate historical "oversight."  Those who place themselves in harm's way deserve no less.  Aloha,

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

 

Sent from my iPhone

ALOHA

TIME FOR DOD AND VA TO TRULY COLLABORATE ?

            P.L. 114-198:  One of the most exciting aspects of being involved in the public policy/political process is the opportunity to sense the future evolving in unexpected venues.  On July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198).  This bipartisan legislation was crafted to “address the national epidemics of prescription opioid abuse and heroin use.”  The USPHS Surgeon General: “Nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.”  The legislation addresses a number of issues which should be of direct interest to military psychologists and your colleagues throughout the public sector, especially those within the VA.  Two underlying themes: * Developing collaborative relationships with the VA and * Ensuring provider accountability, including requiring reports from state medical boards on adverse licensure actions for new hires (Section 941).

            Section 912 requires VA and DoD to ensure that the Health Executive Committee’s Pain Management Working Group (PMWG) includes a focus on the opioid prescribing practices of health care providers of each Department; the ability of each Department to manage acute and chronic pain, including training health care providers with respect to pain management; the use of complementary and integrative health (CAM); the concurrent use by health care providers of opioids and prescription drugs to treat mental health disorders, including benzodiazepines; the use of care transition plans by health care providers to address case management issues for patients receiving opioid therapy who transition between inpatient and outpatient settings; coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from DOD to VA; and the ability to screen, identify, and treat patients with substance use disorders who are seeking treatment for acute and chronic pain.  The law further requires VA and DOD to jointly update the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain within 180 days of enactment.

Section 921 requires that, within 90 days of enactment, and quarterly thereafter, each VA medical facility will host a public community meeting on improving VA health care; and within one year, and at least annually thereafter, that each community-based outpatient clinic shall host such a community meeting.  These meetings will require regular senior leadership attendance and notice will be given to the House and Senate Veterans Affairs Committees, as well as the Members of Congress representing that area.

Section 931 establishes a Commission to examine the evidence-based therapy treatment model used by the VA for treating mental health conditions of veterans and the potential benefits of incorporating CAM as standard practice throughout the Department.   The Commission is to examine the efficacy of the evidence-based therapy model used by the VA and identify areas of improvement.  It will conduct a patient-centered survey within each VISN to examine the experiences of veterans with VA facilities and non-VA facilities and their preferences.  It will also study the prevalence of prescribing medications for those seeking mental health treatment and the research on CAM, including service dogs, acupuncture, yoga, etc.

Section 105 would award demonstration grants to states to streamline the licensure requirements for veterans who held military occupational specialties related to medical care or who completed certain military medical training to more easily meet civilian health care licensure requirements.   Many should be expected to ultimately work within the public sector, particularly within the VA or our nation’s network of Federally Qualified Community Health Centers (FQHCs) which report that 30% of their new hires in the past 2 years were veterans.

APA’s Denver Convention:  The APA Council of Representatives voted to adopt as policy the Resolution on Psychologists in Integrated Primary Care and Specialty Health Settings.  The resolution aims to encourage APA policies and initiatives that advance evidence-based, interprofessional approaches to patient and family health.  “Primary care is considered the ‘de facto’ mental health system where at least 60% of medical visits have psychosocial components; approximately 20% of primary care patients meet criteria for a diagnosis of depression, and roughly 15% have generalized anxiety; depression, anxiety, obesity and smoking are frequently initially treated in primary care settings in adult patients; and attention deficit disorder in typically treated in pediatric primary care.”  “Access to psychological services through the [VA] and [DoD] healthcare systems allows for primary care settings to provide behavioral healthcare to veterans, active duty and retired service men and women and their families.”  And, “Psychologists across the United States increasingly serve in leadership roles….”  Within both Departments, psychologists have been on the cutting-edge of these critical developments.  Col. Becky Porter recently retired as Director of the DiLorenzo TRICARE Health Clinic at the Pentagon, and an Army nurse, Col. Amal Chatila, has now assumed command.  With vision and collaboration, the future is very bright.

The VA is the largest employer of psychologists.  In Denver it was noted that most members are not aware that APA does not have an office of Veterans or Military Affairs, even though one in 10 adults is a Veteran and one in 6 Americans is either a military service member, Veteran, or their dependent.  Division 19, collaborating with VA colleagues, should take the lead in rectifying this unfortunate historical “oversight.”  Those who place themselves in harm’s way deserve no less.  Aloha,

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

 

HONORING THOSE WHO SERVE

Our colleagues who have chosen to work within the nation's public sector are overwhelmingly dedicated to fulfilling a higher mission, that of serving society.  The Presidential term of Tim Carmody was very nicely highlighted at our Denver convention.  The presentation of the Harold M. Hildreth Award was particularly moving, honoring long time APA staff Randy Phelps for his decades of support for those working within the Department of Veterans Affairs (VA) and the entire public sector.  President-Elect Tony Puente and former Division President Femina Varghese spoke glowingly of the Division's appreciation.  Most of us were not aware that APA does not have an office of Veterans or Military Affairs, even though one in 10 adults is a Veteran and one in six Americans is either a military service member, Veteran, or their dependent.  A high priority of President Obama's Patient Protection and Affordable Care Act (ACA) is the development of interdisciplinary team-based care.  This, of course, has long been the strength of the public sector.

            This summer the VA formally proposed to amend its regulations to permit full practice authority for its Advanced Practice Registered Nurses (APRNs) when they are acting within the scope of their VA employment.  Relying upon its federal supremacy authority, the new regulations would preempt individual State nursing licensure laws to the extent to which they would conflict with full practice authority.  By the close of the public commentary period, an extraordinary 223,000 comments had been received approximately 60% supportive.

            Under the leadership of APA immediate Past-President Barry Anton and President-Elect Tony Puente, 16 former APA Presidents submitted a letter in support of the VA's proposal.  The APA Practice Organization signed on to a similar statement as a member of the Coalition for Patients' Rights, along with the American Physical Therapy Association and a number of nursing organizations.  "Our coalition exists because of barriers our members face in providing the care they are trained and certified to deliver….  Efforts to limit scope of practice are unnecessary and impede, rather than enhance, patient access to quality care."  The American Association of Colleges of Pharmacy also submitted highly supportive comments.  The AMA urged the VA: "to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes."  One political pundit opined that the AMA had as much credibility on this issue as the NRA did on gun control.

            The Federal Trade Commission (FTC): "FTC staff support the Department's initiative to maximize its staff capabilities.  Our prior examination of the impact of nursing regulations on health care competition reinforce the VA's view that the Proposed Rule would: * increase the Veterans Health Administration's ('VHA') ability to provide timely, efficient, and effective primary care services, among others; and * increase veteran access to needed health care, particularly in medically underserved areas, as well as decrease the amount of time veterans spend waiting for patient appointments.  These changes in VA policy may also benefit health care consumers in private markets…."

            "FTC staff recognize the critical importance of patient health and safety, and we defer to federal and state legislators to determine the best balance of policy priorities and to define the appropriate scope of practice for APRNs and other health care professionals.  But even well-intentioned laws and regulations may include unnecessary or overbroad restrictions that limit competition.  Undue regulatory restrictions on APRN practice can harm patients, institutional health care providers such as the VHA, and both public and private third-party payors.  The [FTC] Policy Paper observes, in particular, that state-mandated supervision of APRN practice raises competitive concerns, may impede access to care, and may frustrate the development of innovative and effective models of team-based health care."

            "Expert bodies, including the Institute of Medicine ('IOM'), have determined that APRNs are 'safe and effective as independent providers of many health care services within the scope of their training, licensure, certification and current practice.'  FTC staff have recommended, therefore, that policy makers carefully examine purported safety justifications for restrictions on APRN practice in light of the pertinent evidence, evaluate whether such justifications are well founded, and consider whether less restrictive alternatives would protect patients without imposing undue burdens on competition and undue limits on patients' access to basic health care services."

            "FTC staff urge the VA to apply a similar analytical framework.  Granting full practice authority to VA-employed APRNs would benefit both the VA and the patients it serves, consistent with the goals expressed in the Proposed Rule.  APRNs should be able, for example, to evaluate VA patients, order diagnostic tests for them, and manage their treatments without physician involvement or approval as long as they do so within the limits of their education and training.  Furthermore, the VA's actions and leadership on this issue may send an important signal (and generate useful data) regarding the likely benefits of full practice authority for APRNs.  This, in turn, could influence broader policy considerations, as well as provider market entry outside the VA system, both of which may help to bring the benefits of increased health care competition to an even larger number of U.S. citizens and permanent residents….  We strongly believe that full APRN practice authority can benefit the VA's patients and the institution itself, by improving access to care, containing costs, and expanding innovation in health care delivery.  To the extent that the VA's actions would spur additional competition among health care providers and generate additional data in support of safe APRN practice, we believe those benefits could spill over into the private health care market as well."

Reflections from Senior Visionaries:  Over the past several conventions, the Division has sponsored a panel focusing upon "Meaningful Retirement."  Each year the audience has steadily increased, and this year we had 75-80 attendees on a Sunday morning.  Long time VA psychologist and most recently fiction book author, Rod Baker, has been a regular.  He reports: "One lament I hear from some who have retired is that they can no longer have Sunday brunch with long-time virtual friends from around the nation.  I have two thoughts.  Those past relationships can still be relevant if you put some time and energy into those friendships, but not if the association is restricted to an annual Christmas card/letter.  Pining for lost relationships will get you nowhere.  If you miss those past contacts, you have to ask yourself what you have done to maintain them or what you can do to re-ignite them as relevant to your new life.  For psychologists who were active in APA, attending a meeting of APA or its Divisions and inviting others to join you to get together to renew friendships might work.  I value, for example, the past presidents' breakfasts held by Division 18 for the past three APAs.  My second thought is that maybe the focus should be on developing/maintaining and putting new friends and opportunities in your life with those in proximity.  That will still take time and effort.  The decision is yours."

Bruce Overmier, friend and colleague from APA governance days.  "I also like you sense that we must integrate all levels of care.  To me, this also speaks to APA getting back to recognizing MAs as a valid and appropriate and respected part of the psychological practice (and psychological science) spectrum.  Physicians are finally managing to work with 'physician assistants,' maybe we could find it so for our MAs.  I think psychology and APA would be stronger if we did so.  Ah, well; perhaps that is just a foolish hope.  Fighting vested interests is terribly challenging as you well know."  Aloha,

Pat DeLeon, former APA President – Division 18 – September, 2016

 

Sent from my iPhone

ALOHA - D18 Fall column

HONORING THOSE WHO SERVE

            Our colleagues who have chosen to work within the nation’s public sector are overwhelmingly dedicated to fulfilling a higher mission, that of serving society.  The Presidential term of Tim Carmody was very nicely highlighted at our Denver convention.  The presentation of the Harold M. Hildreth Award was particularly moving, honoring long time APA staff Randy Phelps for his decades of support for those working within the Department of Veterans Affairs (VA) and the entire public sector.  President-Elect Tony Puente and former Division President Femina Varghese spoke glowingly of the Division’s appreciation.  Most of us were not aware that APA does not have an office of Veterans or Military Affairs, even though one in 10 adults is a Veteran and one in six Americans is either a military service member, Veteran, or their dependent.  A high priority of President Obama’s Patient Protection and Affordable Care Act (ACA) is the development of interdisciplinary team-based care.  This, of course, has long been the strength of the public sector.

            This summer the VA formally proposed to amend its regulations to permit full practice authority for its Advanced Practice Registered Nurses (APRNs) when they are acting within the scope of their VA employment.  Relying upon its federal supremacy authority, the new regulations would preempt individual State nursing licensure laws to the extent to which they would conflict with full practice authority.  By the close of the public commentary period, an extraordinary 223,000 comments had been received approximately 60% supportive.

            Under the leadership of APA immediate Past-President Barry Anton and President-Elect Tony Puente, 16 former APA Presidents submitted a letter in support of the VA’s proposal.  The APA Practice Organization signed on to a similar statement as a member of the Coalition for Patients’ Rights, along with the American Physical Therapy Association and a number of nursing organizations.  “Our coalition exists because of barriers our members face in providing the care they are trained and certified to deliver….  Efforts to limit scope of practice are unnecessary and impede, rather than enhance, patient access to quality care.”  The American Association of Colleges of Pharmacy also submitted highly supportive comments.  The AMA urged the VA: “to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes.”  One political pundit opined that the AMA had as much credibility on this issue as the NRA did on gun control.

            The Federal Trade Commission (FTC): “FTC staff support the Department’s initiative to maximize its staff capabilities.  Our prior examination of the impact of nursing regulations on health care competition reinforce the VA’s view that the Proposed Rule would: * increase the Veterans Health Administration’s (‘VHA’) ability to provide timely, efficient, and effective primary care services, among others; and * increase veteran access to needed health care, particularly in medically underserved areas, as well as decrease the amount of time veterans spend waiting for patient appointments.  These changes in VA policy may also benefit health care consumers in private markets….”

            “FTC staff recognize the critical importance of patient health and safety, and we defer to federal and state legislators to determine the best balance of policy priorities and to define the appropriate scope of practice for APRNs and other health care professionals.  But even well-intentioned laws and regulations may include unnecessary or overbroad restrictions that limit competition.  Undue regulatory restrictions on APRN practice can harm patients, institutional health care providers such as the VHA, and both public and private third-party payors.  The [FTC] Policy Paper observes, in particular, that state-mandated supervision of APRN practice raises competitive concerns, may impede access to care, and may frustrate the development of innovative and effective models of team-based health care.”

            “Expert bodies, including the Institute of Medicine (‘IOM’), have determined that APRNs are ‘safe and effective as independent providers of many health care services within the scope of their training, licensure, certification and current practice.’  FTC staff have recommended, therefore, that policy makers carefully examine purported safety justifications for restrictions on APRN practice in light of the pertinent evidence, evaluate whether such justifications are well founded, and consider whether less restrictive alternatives would protect patients without imposing undue burdens on competition and undue limits on patients’ access to basic health care services.”

            “FTC staff urge the VA to apply a similar analytical framework.  Granting full practice authority to VA-employed APRNs would benefit both the VA and the patients it serves, consistent with the goals expressed in the Proposed Rule.  APRNs should be able, for example, to evaluate VA patients, order diagnostic tests for them, and manage their treatments without physician involvement or approval as long as they do so within the limits of their education and training.  Furthermore, the VA’s actions and leadership on this issue may send an important signal (and generate useful data) regarding the likely benefits of full practice authority for APRNs.  This, in turn, could influence broader policy considerations, as well as provider market entry outside the VA system, both of which may help to bring the benefits of increased health care competition to an even larger number of U.S. citizens and permanent residents….  We strongly believe that full APRN practice authority can benefit the VA’s patients and the institution itself, by improving access to care, containing costs, and expanding innovation in health care delivery.  To the extent that the VA’s actions would spur additional competition among health care providers and generate additional data in support of safe APRN practice, we believe those benefits could spill over into the private health care market as well.”

Reflections from Senior Visionaries:  Over the past several conventions, the Division has sponsored a panel focusing upon “Meaningful Retirement.”  Each year the audience has steadily increased, and this year we had 75-80 attendees on a Sunday morning.  Long time VA psychologist and most recently fiction book author, Rod Baker, has been a regular.  He reports: “One lament I hear from some who have retired is that they can no longer have Sunday brunch with long-time virtual friends from around the nation.  I have two thoughts.  Those past relationships can still be relevant if you put some time and energy into those friendships, but not if the association is restricted to an annual Christmas card/letter.  Pining for lost relationships will get you nowhere.  If you miss those past contacts, you have to ask yourself what you have done to maintain them or what you can do to re-ignite them as relevant to your new life.  For psychologists who were active in APA, attending a meeting of APA or its Divisions and inviting others to join you to get together to renew friendships might work.  I value, for example, the past presidents’ breakfasts held by Division 18 for the past three APAs.  My second thought is that maybe the focus should be on developing/maintaining and putting new friends and opportunities in your life with those in proximity.  That will still take time and effort.  The decision is yours.”

Bruce Overmier, friend and colleague from APA governance days.  “I also like you sense that we must integrate all levels of care.  To me, this also speaks to APA getting back to recognizing MAs as a valid and appropriate and respected part of the psychological practice (and psychological science) spectrum.  Physicians are finally managing to work with ‘physician assistants,’ maybe we could find it so for our MAs.  I think psychology and APA would be stronger if we did so.  Ah, well; perhaps that is just a foolish hope.  Fighting vested interests is terribly challenging as you well know.”  Aloha,

Pat DeLeon, former APA President – Division 18 – September, 2016

 

 

“A FUNDAMENTAL CONCERN FOR OTHERS....”

Our 124^th Annual Convention:  This year's APA convention in Denver was very pleasant.  The Karl F. Heiser Awards Ceremony, chaired by APA President Susan McDaniel and the Division's Tom DeMaio, was particularly moving.  The Iowa Psychological Association's prescriptive authority success was highlighted; with Bethe Lonning, Brenda Payne, and Greg Febbarro (posthumously) being honored.  Most State Psychological Associations assume that to enact such far reaching legislation over the vocal objections of organized psychiatry is a very expensive undertaking.  It did take Iowa a decade; however, Bethe indicated that since 2011 they had only needed to raise $3,535.50.  The key to their success was grassroots campaigning and sincerely believing that what they were proposing was important for the citizens of Iowa.  It was refreshing that the Board of Directors, under the leadership of Susan and Interim CEO Cynthia Belar, were responsive to engaging society's "issues of the day."  Those supportive of the Black Lives Matter movement had a distinctive presence at the convention and representatives of the Board and Council (Tony Puente and Jennifer Kelly) went out and greeted those marching to show support.  The Board also hosted a meeting of leaders in the police and public safety community to discuss how organized psychology can best help.  We would suggest that our State Psychological Associations should initiate similar involvement at the local level as we know that psychological science has much to contribute in solving societal problems.

Effectively Addressing National and Local Needs:  The Health Resources and Services Administration (HRSA) reports that mental health disorders rank in the top five chronic illnesses in the nation.  An estimated 25% of the adults currently suffer from mental illness and nearly half of all adults will develop at least one mental illness in their lifetime.  In 2007, over 80% of those seen in the emergency room (ER) had mental disorders diagnosed as mood, anxiety, and alcohol related disorders.  The need for integrated care should immediately come to mind.

In Hawaii, Dina Shek, working collaboratively with her colleagues in the William S. Richardson School of Law, has actively engaged students from the various health professional programs (including law) in obtaining clinical experiences within two of the state's federally qualified community health centers (FQHCs).  She is now exploring developing a mental health-focused Medical-Legal Partnership with the Hawaii Disability Rights Center.  During the academic year 2014-2015, the HRSA Graduate Psychology Education (GPE) initiative supported clinical training at 340 partnered sites incorporating interdisciplinary team-based approaches, where approximately 1,900 students and advanced trainees from a variety of professions trained alongside GPE-sponsored trainees.  More than 210 faculty members participated in 42 GPE-sponsored faculty development activities focusing upon a wide variety of emerging topics in mental and behavioral health.  Approximately 22% of the GPE students reported coming from disadvantaged backgrounds and upon graduation 87% intend to pursue employment in medically underserved communities (MUCs).

We would suggest that are these are exactly the types of creative initiatives which State Psychological Associations should explore at annual meetings and/or at interprofessional dinners with their local legal, nursing, pharmacy, social work, and medical associations.  Susan McDaniel's APA Presidency has been all about the opportunities ahead for visionary psychologists.  State Psychological Associations should be the critical catalysts.  "Would go a long way in making the world the better place we so passionately dreamt of."  Aloha,

Pat DeLeon, former APA President – Division 31 – September, 2016

 

Sent from my iPhone

ALOHA - Division 31 September column

“A FUNDAMENTAL CONCERN FOR OTHERS....”

Our 124^th Annual Convention:  This year’s APA convention in Denver was very pleasant.  The Karl F. Heiser Awards Ceremony, chaired by APA President Susan McDaniel and the Division’s Tom DeMaio, was particularly moving.  The Iowa Psychological Association’s prescriptive authority success was highlighted; with Bethe Lonning, Brenda Payne, and Greg Febbarro (posthumously) being honored.  Most State Psychological Associations assume that to enact such far reaching legislation over the vocal objections of organized psychiatry is a very expensive undertaking.  It did take Iowa a decade; however, Bethe indicated that since 2011 they had only needed to raise $3,535.50.  The key to their success was grassroots campaigning and sincerely believing that what they were proposing was important for the citizens of Iowa.  It was refreshing that the Board of Directors, under the leadership of Susan and Interim CEO Cynthia Belar, were responsive to engaging society’s “issues of the day.”  Those supportive of the Black Lives Matter movement had a distinctive presence at the convention and representatives of the Board and Council (Tony Puente and Jennifer Kelly) went out and greeted those marching to show support.  The Board also hosted a meeting of leaders in the police and public safety community to discuss how organized psychology can best help.  We would suggest that our State Psychological Associations should initiate similar involvement at the local level as we know that psychological science has much to contribute in solving societal problems.

Effectively Addressing National and Local Needs:  The Health Resources and Services Administration (HRSA) reports that mental health disorders rank in the top five chronic illnesses in the nation.  An estimated 25% of the adults currently suffer from mental illness and nearly half of all adults will develop at least one mental illness in their lifetime.  In 2007, over 80% of those seen in the emergency room (ER) had mental disorders diagnosed as mood, anxiety, and alcohol related disorders.  The need for integrated care should immediately come to mind.

In Hawaii, Dina Shek, working collaboratively with her colleagues in the William S. Richardson School of Law, has actively engaged students from the various health professional programs (including law) in obtaining clinical experiences within two of the state’s federally qualified community health centers (FQHCs).  She is now exploring developing a mental health-focused Medical-Legal Partnership with the Hawaii Disability Rights Center.  During the academic year 2014-2015, the HRSA Graduate Psychology Education (GPE) initiative supported clinical training at 340 partnered sites incorporating interdisciplinary team-based approaches, where approximately 1,900 students and advanced trainees from a variety of professions trained alongside GPE-sponsored trainees.  More than 210 faculty members participated in 42 GPE-sponsored faculty development activities focusing upon a wide variety of emerging topics in mental and behavioral health.  Approximately 22% of the GPE students reported coming from disadvantaged backgrounds and upon graduation 87% intend to pursue employment in medically underserved communities (MUCs).

We would suggest that are these are exactly the types of creative initiatives which State Psychological Associations should explore at annual meetings and/or at interprofessional dinners with their local legal, nursing, pharmacy, social work, and medical associations.  Susan McDaniel’s APA Presidency has been all about the opportunities ahead for visionary psychologists.  State Psychological Associations should be the critical catalysts.  “Would go a long way in making the world the better place we so passionately dreamt of.”  Aloha,

Pat DeLeon, former APA President – Division 31 – September, 2016