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
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