“WITH ONE FOOT ON THE PLATFORM AND THE OTHER FOOT ON THE TRAIN”
OUR Nation’s 45th President – “Interesting Times” for Sure: Those who attended this spring’s APA Practice Organization’s State Leadership Conference should not be surprised with the ultimate outcome. Political analyst Mark Shields provided an insightful historical perspective. The last time a Democrat succeeded a two-term member of his/her own party in the White House was 1836, when Martin Van Buren was elected to succeed Andrew Jackson. 2016 is the fourth time in our nation’s history that the President-elect lost the popular vote. President Donald J. Trump will be our oldest first-term President. Throughout his campaign and continuing after his election, he has called for repealing Obamacare (ACA). During the first 100 days of his Administration, he has proposed to fight for the passage of: “Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds.”
One can wonder about the fate of those 32+ million Americans who but for the enactment of the ACA would not be receiving primary care with its emphasis upon 10 essential health benefits; which include rehabilitative, preventive, wellness, and chronic disease management services. Everyone seems to appreciate the elimination of the “preexisting condition” barrier; although many practitioners are having trouble with the evolution towards population-based (with its emphasis upon health disparities), value/evidence-based, care in contrast to our historical volume-based care. Will the Republican controlled Congress ultimately enact such far-reaching legislation? Political observers have seen the U.S. Senate slowly, but steadily, watering down the inherent protections of its historical filibuster authority, instead moving towards the “nuclear option” when short-term frustrations have overridden historical perspectives. Given the economic projections involved, perhaps, as the Uniformed Services University of the Health Sciences (USUHS) medical historian has suggested, our nation is actually moving towards the Single Payer system proposed by Presidential candidate Bernie Sanders? We shall soon see the results of President Trump’s First 100 Days.
Continuing Steps for Ensuring Quality “Health Care” by Engaged Colleagues: “I’m excited to share our work leading Hawaii’s first Medical-Legal Partnership for Children (MLP) program – a collaborative project between the University of Hawaii Law School and Medical School, and two community health centers (Kokua Kalihi Valley and Waimanalo Health Center). As the only law and medical schools in the State of Hawaii, this collaboration provides significant interdisciplinary training opportunities for the next generation of Hawaii’s professionals. We follow three core activities (as established by the National Center for Medical-Legal Partnerships): 1. Providing free, direct legal services for low income families, on-site at a community health center. 2. Training health professionals about the underlying legal needs of low-income patients. And, 3. Engaging together to address systemic advocacy, including policy matters and community empowerment.
“Briefly, our work helps low-income patient-families in areas of housing (preventing evictions, winning credits for public housing residents wrongly overcharged, ensuring disability access, etc.), strengthening families through family law (guardianships, powers of attorney, child support, and domestic violence advocacy), filing discrimination complaints in employment and housing, and preserving much-needed public benefits for our most vulnerable children. In addition, we are dedicated to community education and empowerment, focusing on ‘know your rights’ training and self-advocacy skills, especially for immigrant families in Hawaii. This work has led low-income participants to successfully assert their rights in housing, healthcare (especially around language access), education, and other areas. We have also increased our clients’ capacity to participate in civic engagement and policy matters; much of our work has been focused on access to healthcare for Micronesian migrants in Hawaii.
“As a project of the University of Hawaii, we have strong relationships with other university programs, including public health, public administration, social work, nursing, and education. This is especially important as we seek support to better evaluate our impact, especially looking beyond quantitative measures to include qualitative measures and our impact in addressing the social-determinants of health. Those interdisciplinary connections are so crucial to better health and wellness [Dina Shek].”
Give an Hour: Barbara Van Dahlen, Founder & President of Give an Hour, is constantly striving to Change the Direction of how our nation views mental health. Given the historical stigma, her efforts are critical for integrated holistic/behavioral health care for all Americans. Give an Hour has provided over 200,000 hours of free mental health care (valued at over $20 million) to our nation’s active duty personnel, Veterans, and their families. This year Barbara has particularly focused upon the role of motion pictures in shaping our nation’s attitudes and expectations (i.e., our culture). In the fall, she arranged for Wendy Anderson, executive producer, and psychologist Jerry Sullivan to participate in a panel discussion and screening of “Citizen Soldier” at USUHS. The film provides a dramatic look at the realities of combat from the point of view of a group of Soldiers in the Oklahoma Army National Guard’s 45th Infantry Brigade Combat Team, known since WWII as the “Thunderbirds,” who were deployed to one of the most dangerous parts of Afghanistan at the height of the surge.
“USUHS students Michelle Binder and Annie Barajas (both USAF Captains and Psychiatric Nurse Practitioner DNP students) attended the screening and found the film to be a valuable tool for mental health providers as well as patients’ families. While speaking with the executive producer after reviewing the film, they promised that they will ensure that every mental health provider in their future clinics would watch the film. ‘This film will save families… I’m sure it has already saved lives.’ Both students felt the movie conveyed the story of soldiers’ wartime experiences in a palpable way – riveting viewers while also eliciting empathy and a brief glimpse into what these citizen soldiers go through before, during, and after war. ‘I’ve been deployed, but I haven’t seen direct combat. I understand how it feels to come home and feel detached and isolated, but this film gives me a much clearer perspective on the combat experience and the importance of unit cohesion.’ ‘We both feel that the Campaign to Change Direction’s initiative, using film to change the narrative about mental health, will make a huge impact – especially on this young generation of military service members.’” The film used real footage from multiple cameras, including helmet cams, providing an intimate view into the chaos and horrors of combat and, in the process, displayed the bravery and valor of the Thunderbirds under the most hellish of conditions. Nineteen Oklahoma National Guard troops lost their lives in Iraq and Afghanistan between 9/11 and March, 2016.
Critical to the successes of Dina’s Medical-Legal Partnership, Wendy Anderson’s intimately moving documentary, and Give an Hour is their consistent appreciation for the importance of community engagement and empowerment. Without the time and effort invested in building relationships and trust with those most impacted, these important initiatives would not have been possible. This is a fundamental approach to addressing society’s most pressing needs that is often overlooked by those who perceive themselves as being “in power” and/or possessing special skills, whether they are clinical or intellectual/artistic.
Given the importance of APA’s State Associations to all of psychology, we were very pleased to learn that Give an Hour has now developed their first major State Association collaborative partnership with our colleagues in New Hampshire. They will be engaging psychologists to “Join Give an Hour to Change Direction.” Practitioners from the Granite State will donate their hour a week to provide care, consultation, expertise – across a number of areas – to service members and Veterans – and to other at risk groups in their state. Barbara is proud to be partnering with the New Hampshire Psychological Association on this critical effort and encourages other associations to join Give an Hour and the Change Direction initiative. As she notes, “Psychologists have unique skills and abilities that are sorely needed in communities across the country. We encourage every State Association to join us as we Change the Culture of mental health by increasing access to care and by educating all Americans to recognize the signs of emotional suffering. Providing care to those in need enriches the lives of those who give as well as those who receive and elevates the value of our profession.”
Currently there are more than 19 million Veterans living in the United States. The largest cohort (6.2 million) represents Vietnam Veterans 270,000 of whom are diagnosed with PTSD; one-third also exhibit co-morbid depression and anxiety. The VA reports that every day 20 Veterans commit suicide, over 65% are over the age of 50, disproportionately representing those who served during Vietnam. APA does not have an Office of Veterans Affairs. Why not? Has your Division and/or State Association leadership spoken out on this issue? “A house in New Orleans they call the rising sun.” Aloha,
Pat DeLeon, former APA President – Division 42 -- November, 2016
