Those of our colleagues who have had the opportunity during their careers to serve in both the Administration and on the Hill have had the fascinating experience of developing a personal appreciation for how the different branches of government have unique aspirations, cultures, and challenges; as well as how government can truly "make a difference" in the lives of our nation's citizens. From the Hill perspective, one develops an instinctive sense for when fundamental change is evolving. Now retired, Hawaii's U.S. Army Colonels Debra Dunivin and Ernie Lenz have the distinction of having been selected as APA Congressional Science Fellows. With the change in Administration, Mary Wakefield completed her tenure as Acting Deputy Secretary of the Department of Health and Human Services (HHS). Previously, she had served as chief-of-staff for two of North Dakota's U.S. Senators.
The Fiscal Year 2017 Appropriations Legislation [P.L. 115-31]: Movement -- "Concerns remain with the progress being made by the Departments of Defense and Veterans Affairs to fully develop, procure, and deploy an interoperable electronic health record solution. The two systems must be completely and meaningfully interoperable, and the Under Secretary of Defense (Acquisition, Technology, and Logistics) is encouraged to focus on the overall goal of seamless compatibility between the two Departments' electronic health record systems…. These [quarterly] reports should also include any changes to the deployment timeline, including benchmarks, for full operating capability; …the status of the effort to achieve interoperability between the electronic health record systems of the Departments of Defense and Veterans Affairs, including the scope, cost, schedule, mapping to health data standards, and performance benchmarks of the interoperable health record; and the progress toward developing, implementing, and fielding the interoperable electronic health record throughout the two Departments' medical facilities.
"The PEO DHMS is directed to continue briefing the House and Senate Appropriations Committees on a quarterly basis, coinciding with the report submission. Given that full deployment of this new electronic health record is not scheduled until fiscal year 2022, the Department of Defense is expected to continue working on interim modifications and enhancements to the current system to improve interoperability in the near-term…. Additionally, the Director of the Interagency Program Office is directed to continue to provide quarterly briefings on standards development, how those standards are being incorporated by the two Departments, and the progress of interoperability…. In an effort to ensure government-wide accountability, the PEO DHMS, in coordination with the appropriate personnel of the Department of Veterans Affairs, is directed to provide the Federal Chief Information Officer of the United States with monthly updates on progress made by the two Departments to reach interoperability and modernize their respective electronic health records."
The Times They Are A-Changin': At a recent Give an Hour event hosted by President Barbara Van Dahlen, USUHS psychology graduate student Elizabeth Belleau met VA Secretary David Shulkin and Harold Kudler, chief consultant for mental health service. Among other issues, they discussed the exciting potential for active duty mental health graduate students to obtain supervised clinical experience within the VA – especially since these future colleagues personally appreciate the nuances of military culture and will themselves eventually become VA beneficiaries (i.e., breaking down historical silos). Impressively, Give an Hour has already provided over 220,000 hours of free mental health care (valued at over $20 million) to our nation's active duty personnel, Veterans, and their families. The Secretary, who is the first non-Veteran to be appointed, has entered into a partnership with HHS to allow the assignment of U.S. Public Health Commissioned Corps members to provide direct patient care to Veterans in VA hospitals and clinics in underserved communities. Earlier this year, he was instrumental in providing full practice authority for VA advanced practice registered nurses (APRNs) (with the exception of nurse anesthetists) as long as they were working within the scope of their VA employment.
Prescriptive Authority (RxP): The APA Board of Educational Affairs and CAPP will be establishing a Task Force to Review and Revise the APA Recommended Postdoctoral Education and Training Program in Psychopharmacology for RxP. The federal system, and particularly DoD, was the critical catalyst for this evolution, affirmatively demonstrating that appropriately trained colleagues could provide safe and quality psychopharmacological care. Floyd Jennings, USPHS; John Sexton and Morgan Sammons, U.S. Navy; and Debra Dunivin, U.S. Army were among the first prescribing psychologists. At the time of the adoption of the 2009 APA model curriculum, the consensus was to require postdoctoral training. Several of the underlying issues to be considered at this point, however, include: * At what level is it appropriate to begin such training and what components of the training can be taken at what level? * The balance between enough specificity in the required elements of the curriculum to ensure consistent training vs. allowing program flexibility. And, * The components of the supervised experience. The Task Force will also explore the similarities and differences in the various enacted RxP state laws.
With the steady movement of psychology towards integrated, team-based care it is my personal view that APA's new standards should strive to reflect the views of the practicing clinician, actively engage graduate students, and provide training programs with the flexibility to educate interested students throughout their doctoral training. APA's original task force on RxP concluded in 1993: "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." (Michael Smyer, chair; current APA President Tony Puente, an active participant). "To be perfect is to change often." Aloha,
Pat DeLeon, former APA President – Division 19 – May, 2017
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