“I AM A ROCK – I AM AN ISLAND”
The APA and APA Practice Organization Practice Leadership Conference (PLC): One knows that spring has arrived in our nation’s Capital when the talk of the town becomes the annual cherry blossom festival, perhaps the last snow storm of the year, and the APAPO state leadership conference, which is always the highlight of my APA year. Renamed this year as PLC, over 400 colleagues enthusiastically attended “Practice, Politics & Policy.” HPA President-Elect Tanya Gamby led the Hawaii delegation, with executive director Ray Folen actively attempting to herd the crew to their various scheduled venues. Once again, Dan Abrahamson and Susie Lazaroff did an outstanding job and it was particularly nice to have Congressman Tim Murphy (R-PA), who is a psychologist, honored for his outstanding contributions to our nation’s mental health and substance abuse programs.
APA President Tony Puente and President-Elect Jessica Henderson Daniel were ever-present, as was former HPA President Kate Brown now serving as Chair of CAPP. At PLC we learned that Kate’s fellow CAPP member, June Ching, will soon join the National Register Board of Directors. Personally, I particularly appreciated Tony Puente’s efforts to actively engage those early career psychologists and graduate students who were present in shaping the future of their profession. Sybil Mallonee (1st Lt., USA) is a graduate student at USUHS: “As a student attending the APA’s Practice Leadership Conference for the first time, it was an amazing and exciting experience. It was amazing seeing so many clinicians from all stages in their career come together to advocate for our field. It was exciting to have the opportunity to be mentored by so many incredible clinicians who were eager to pass on their knowledge to the upcoming generation of psychologists. It was also exciting to see such an emphasis on the importance of diversity and on having the sometimes challenging conversations around issues related to diversity. There were many great speakers throughout the conference, but the one that stands out the most was the diversity panel. This panel was of psychologists sharing challenging conversations and experiences related to diversity. In keeping with the theme of the conference as a whole, their stories were inspiring to this future psychologist. They were honest and challenging, but they also emphasized the importance of not losing your voice and of standing up for what is right.”
Katherine Nordal was most impressive in crystalizing the notion of promoting psychologists by advancing the trade of professional psychology – truly a new message for a number of our colleagues – and by each of us contributing to our Political Action Committee (PAC). Today, the national psychology PAC ranks 44th among 129 health professional PACs with dentistry, medicine, optometry, nursing, physical therapy, podiatry, social work, and psychiatry significantly ahead of us. I would rhetorically ask: What percent of the membership has contributed to HPA’s PAC?
Hawaii psychologists are very fortunate in that our state has long possessed a Congressional delegation which truly appreciates the value of psychological care. Kathy McNamara describing one of her recent Hill visits: “While in Washington in September for Hill meetings, I had an opportunity to meet with our Senator Mazie Hirono. She voiced her absolute support of efforts to improve access to quality mental health care. While I appreciated the Senator’s statement of support, I appreciated even more the time she then took to stay in a conversation with me, sharing about her childhood in Japan, with a fond memory of being with her mother and eating persimmons (a reference to our persimmons season in Hawaii!). Among other personal aspects of her background, she proudly mentioned that her undergraduate major was Psychology, so her interest in psychological services has been long-standing. What a gracious, competent, and compassionate side of Senator Hirono was evident in this visit.”
The Prescribing Psychologist (RxP) Evolution: At PLC there were a number of interesting informal discussions following up on the success of Bethe Lonning and her colleagues in Iowa in having their RxP legislation enacted into public law. The Connecticut Psychological Association (CPA) RxP Task Force just completed a survey of 900 licensed psychologists in their state and found that 70 percent supported RxP for properly trained psychologists (Anne Klee and Barbara Bunk). Robin Henderson noted that RxP is once again alive in Oregon – this time being advocated for by non-psychologists. Recall that in 2010 their legislation was vetoed by the Governor. Beth Rom-Rymer is pleased with the progress they are making in Illinois in implementing their law.
All the proposed RxP legislative bills have referenced graduates taking a nationally recognized exam. The Psychopharmacology Examination for Psychologists (PEP) exam is in the process of being transferred from the APA Practice Organization to ASPPB, with the original PEP examination remaining available to candidates until March 30, 2017. This January, ASPPB, which has been intimately involved from the very beginning, issued a broad call for volunteers to assist in developing the new version of the national exam. “An exam of this nature requires periodic updates to ensure that it continues to assess current knowledge required for competent practice.” With change comes opportunity; perhaps the time has come for APA to embrace pre-doctoral training rather than exclusively focusing upon post-doctoral models. Beth’s vision of a vibrant state with undergraduates, graduate students, and practicing psychologists working towards becoming prescribing psychologists, working in concert with Illinois’ largest social service organizations, NAMI, the prison system, Illinois’s largest academic and research medical institutions, major medical centers, and smaller community hospitals is coming to fruition.
In reviewing some of the statements made on the floor of the Hawaii State Legislature in opposition to Hawaii’s RxP legislation, I could not help but reflect that these are not uncommon views being said in other states. They present an opportunity for psychologists to do more and particularly to personally meet with their own local elected officials to discuss how rigorous their doctoral training was. The essence of several of the statements is that those licensed psychologists who are pursuing RxP are “public health hazards” who would affirmatively harm their patients. “One of the basic concerns we had last year, when the bill was killed, was safety. We have, I believe, inadequate basic education amongst some of these people who will be prescribing medication. Many of the people do not have basic science education. Some of these people come from private universities which have very low entrance requirements.” “I’ll be voting no on this measure, because we are playing games with people’s health…. And I believe that they are not qualified to do it, and because of that, and in the interest of being cautious, we should, I am voting no on this measure.” One can reasonably agree or disagree on the RxP agenda. One could also argue that when non-physicians, such as Advanced Practice Registered Nurses (APRNs) and Clinical Pharmacists, are actively engaged in the prescriptive process, more appropriate and more judicious use of medications is the result; that is, an overall higher quality of health care is provided. “As of today, Hawaii’s SB 384 has made it through crossover and is being heard in the House Health Committee this Thursday. We’re still alive!” [Jill Oliveira Gray].
Earlier this year South Dakota became the 22nd state in the nation, plus the District of Columbia, to have Full Practice Authority for Nurse Practitioners. In January, the Department of Veterans Affairs (VA), utilizing its federal preemption authority, issued regulations granting Full Practice Authority for APRNs (other than nurse anesthetists) regardless of State or local law restrictions, when the APRN is working within the scope of their VA employment. This authority includes providing diagnosis and treatment of health or illness states, disease management, health promotion; and prevention of illness and risk behaviors among individuals, families, groups, and communities. It also expressly authorizes prescribing medication and durable medical equipment. “And a rock feels no pain. And an island never cries.” Aloha,
Pat DeLeon, former APA President – HPA – March, 2017
