“LIVING LABORATORIES FOR MEANINGFUL CHANGE”
In many ways, these are truly “interesting times” which can provide public sector psychology with unprecedented opportunities to make a real difference in the daily lives of their patients. Public service often represents society’s “safety net.” This spring, as Interim APA CEO, Cynthia Belar established the position of Director of Military and Veterans Health Policy, to be located within the Practice Organization. And, Cynthia appointed Heather O’Beirne Kelly as the director for this new and exciting initiative. Heather has worked for APA for nearly two decades and one of her top priorities is to facilitate the acceptance of appropriately trained prescribing psychologists (RxP) within the Department of Veterans Affairs (VA). She recently testified before the House of Representatives Appropriations Committee urging the adoption of a pilot RxP project, similar to that once contemplated by then-VA Secretary Anthony Principi under President G.W. Bush. Data recently provided by Bob McGrath and Beth Rom-Rymer indicates that New Mexico has 12 conditional prescribers and 45 prescribers; while Louisiana has 120 medical psychologists. The Department of Defense (DoD) and the U.S. Public Health Service (including the Indian Health Service) utilize prescribing psychologists. Morgan Sammons, John Sexton, and Floyd Jennings (1986) were among the first colleagues to be formally authorized to use these clinical skills – decades ago.
Over the years we have come to appreciate that in order to make a significant and lasting difference in the public policy arena, one must possess vision, be personally involved, and be willing to remain committed over a prolonged period of time. The public sector has historically provided psychology with outstanding opportunities to develop creative, cutting-edge training initiatives. For example, DoD initiated the first RxP training program with Morgan and John graduating in 1994. Today, thanks to the leadership of Robert Zeiss and his successor Ken Jones, the VA Office of Academic Affiliations supports 440 post-doctoral positions annually.
It would seem highly appropriate, therefore, for those interested in advancing the RxP agenda to capitalize upon the closed-system, interdisciplinary/integrated nature of the public sector to provide psychopharmacology training experiences for interns/trainees, thereby effectively capitalizing upon these “living laboratories.” The beneficiary population’s need for these services cannot be questioned; the relevant professional shortages are well documented. For example, shouldn’t our next generation of colleagues have ready access to the didactic RxP training modules during their internship experiences when they could simultaneously receive face-to-face consultation from their clinical supervisors? Across the various health professions, on-line and distance/virtual reality training opportunities are increasingly being utilized. Advances occurring within the communications field are making this technologically feasible.
Uniformed clinical psychology students at the DoD Uniformed Services University of the Health Sciences (USUHS) incur a seven year service pay-back obligation upon completion of their degree. During their clinical training they are routinely exposed to a wide range of clinical and operational experiences which ultimately can lead to assignments aboard the aircraft carrier U.S.S. George H.W. Bush (CVN 77) and in Antarctica; being embedded on the front lines; exposed to natural, man-made, and global disasters, as well as population responses to deadly epidemics; utilization of telehealth; mountain and wilderness training, etc. In many ways, these future colleagues should (and perhaps, must) possess the broadest range of clinical skills. At USUHS there is interest among the students in obtaining their RxP training at the graduate school level, as their psychiatric nursing student (DMHP) colleagues do. Appropriately, teamwork, interdisciplinary training, and operational mental health experiences are a priority of the university.
Several years ago with the active support of Division 18 leadership, Steve Tulkin and Beth proffered the vision of encouraging public service psychologists to enroll in the Alliant International University RxP training program. The next logical evolution would seem to be encouraging public service oriented-graduate students to systematically obtain this knowledge. The issue of the appropriateness of post-doctoral status vs. graduate student status, as conceptualized by the APA Council of Representatives back in 1996, could appropriately be debated at the state licensure level and perhaps during the administration of the revised PEP (Psychopharmacology Examination for Psychologists) exam, which is currently being developed by the Association of State and Provincial Psychology Boards (ASPPB). Psychology prides itself on being one of the “learned professions.” “Giving away psychology” and enhancing educational opportunities are fundamental values of the field. Accordingly, I recently raised this possibility with two of the RxP training directors urging that their programs actively encourage the enrollment of USUHS students. To my surprise, each independently raised the specter of APA designation procedures being the major obstacle.
The Case Example: “I am a graduate student hoping to enroll in the M.S. in Clinical Psychopharmacology program while in graduate school. However, I need the program director to waive the requirement of having a license in psychology to enroll. I feel my previous academic experiences have prepared me well for this program. I have previously taken graduate coursework in: physiology (with doctoral nursing students), psychopharmacology, neurobiology, and endocrinology. I also completed several research projects in the field of psychopharmacology. I have recently completed my core coursework required for my Ph.D. at USUHS and want to further my education in this area. I am hoping to start courses in clinical psychopharmacology in 2018 (USUHS graduate student).”
“This is an issue with the APA Designation criteria. In our APA designation review this became a significant issue and I agreed to stop any future admits of students who had not yet received their doctorate. I feel I must be consistent with what I agreed to in our last designation review. Is there some process for seeking a waiver? I would not only want to admit military students, but would make it possible for there to be some tuition scholarship for your colleague and other students in military training/placements. The APA Designation Criteria: P1. Admissions: To participate in postdoctoral education and training in psychopharmacology, programs must require that students meet the following prerequisites: 1. Be a graduate of a doctoral program in psychology; 2. Hold a current state license as a psychologist; and, 3. Practice as a ‘health service provider’ psychologist as defined by state law, where applicable, or as defined by APA (Alan Lincoln, Interim RxP Program Director, Alliant International University).”
APA’s Catherine Grus subsequently clarified that the model curriculum states: “The program could develop policies for allowing credit from a previous graduate or postdoctoral education and training program(s). To ensure that the training experience is up-to-date, sequential, and cumulative, transfer of a limited number of credits as appropriate for previous coursework is not to exceed twenty percent (20%) of the postdoctoral curriculum and is to be limited to the basic science and neuroscience domains (Domains I & II).”
I would raise the underlying educational policy question: Is it appropriate for APA’s designation system to preclude future members of our profession from obtaining the most up-to-date clinical knowledge? I personally do not think so and believe that such an approach clearly does not fulfill, or even support, our societal obligations. Former APA President Ron Fox, who has been involved in the RxP quest from the very beginning: “As a Past President of APA and Division 55 and as chair of the committee which wrote the designation guidelines, admitting such students to help them get a leg up in the academic portion of their RxP studies seems logical and in keeping with what the original drafters had in mind. To be threatened with loss of designation status seems an overreach that does not serve the best interest of our profession, our students, or society.” Change can be uncomfortable for many. Aloha,
Pat DeLeon, former APA President – Division 18 – June, 2017
