ONE MAN WITH CONVICTION WILL OVERWHELM A HUNDRED WHO HAVE ONLY OPINIONS

The 2018 elections will definitely bring a new face and new voice to the U.S. Congress. More than 100 women are projected to win seats in the House of Representatives; an all-time record with women never having held more than 84 seats in the past. Many of these victorious candidates campaigned on the need for better health care for all Americans. They came from a wide variety of backgrounds, from military Veterans to teachers, and many had never run for office before. On Election Day Veterans won at least 77 House seats, joining 15 others already in the U.S. Senate. Together, they represent the largest cohort of Veterans in Congress in almost a decade. For much of the later part of the 20th century Veterans accounted for more than half of the Members of Congress; their percentage shrinking to less than 20% in recent years. As The Washington Post noted: "Veterans – trained in teamwork, and perhaps less invested in proving their toughness with public put-downs and posturing – are more inclined to work across the aisle…. (They) sign on to bipartisan legislation more often than Members who have not served in the military."

Long time VA visionary and public servant Russell Lemle, along with colleagues Joan Zweben and Joe Ruzek, have been working with the non-profit Veterans Healthcare Policy Institute (VHPI) to ensure that the Veterans Health Administration (VHA) will be strengthened and reformed, and not dismantled and privatized, as some leading political commentators have suggested. They have produced detailed analyses about the impact of various proposed policies on Veterans, written investigative pieces on mental health Choice options, and placed interdisciplinary-oriented briefs into the official record of Congressional hearings. They have especially worked to elevate the positive stories of Veterans' healthcare experiences, with the active support of former heads of various governmental healthcare agencies and a dedicated group of Veterans, healthcare providers, journalists, and activists. Suzanne Gordon, another VHPI analyst, just published an incisive book, Wounds of War, that illuminates the innovate care throughout the VHA system, devoting eight chapters to mental health. These efforts are more important than ever as the Administration continues to contemplate outsourcing much of traditional VA healthcare to the private sector, while downsizing VHA facilities. Russell is increasingly optimistic that their collective voices will be heard by the new Congress.

Another visionary colleague, Femina Varghese, serves as Associate Editor for the Division 18 journal Psychological Services, where she strives to expose our nation's public service colleagues to the evolving trends of the future; for example, interprofessional, team-based integrated care and how the unprecedented developments within the technology field will continue to have a major impact upon healthcare. She was recently awarded $350,000 from the Robert Wood Johnson Foundation (RWJF) for her project "Regional Expansion of Treatment for Addiction in Corrections via Tele-Health: Project REACH." Femina, who is at the University of Central Arkansas, and her colleagues, Nickolas Zaller (University of Arkansas for Medical Sciences) and Ben Udochi (Arkansas Department of Community Corrections), are the principal investigators. Their project will provide counseling services through video conferencing to parolees in rural Arkansas to target risk factors to recidivism. It was selected as part of the competitive RWJF Interdisciplinary Research Leaders program, which engages both researchers and community partners to strengthen communities towards positive health outcomes. Counseling psychology doctoral students from the University of Central Arkansas's APA accredited PhD program will be delivering supervised services through telehealth. The students are excited to have the experience of providing services to such a marginalized population using up-to-date technology. Their aspiration is to develop a model for a rural telehealth program to provide treatment for behavioral health disorders in a community corrections office. They hope that their findings will increase the use of telehealth services to reach correctional populations and thereby provide needed services.

Nick Cummings served as APA President in 1979 and is well known for his highly accurate, although often quite unpopular, predictions, over the years, regarding the nation's ever-evolving healthcare environment. "The terrible massacre in Pittsburg has caused us to focus on anti-Semitism; but this is only the latest in a series of extensive murders by mentally ill persons with so-called 'honorable' miss-beliefs. Having lived to age 94, I remember well the era when mentally ill persons were by law forcibly hospitalized. There were no such murders then, but the system was much abused. For example, gay men were regarded as 'mentally ill' and were subjected to hospitalization until they ostensibly demonstrated they had become heterosexual. As a result, the mental hospital system was over-flowing with patients who did not belong there. Even worse was the subsequent era of Dr. Freeman who purported to 'cure' the mentally ill by giving them all a lobotomy. Mental hospitals lined up mentally ill patients while Freeman performed one prefrontal lobotomy after another using a box of ordinary non-sterilized ice picks, throwing each away after use. I recall when Freeman bragged he had performed his number 5,000 lobotomy. Mental hospitals would line up their hapless patients upon his arrival. Because hospitalized patients did not (could not) commit crimes, the absurd conclusion was reached that mentally ill patients were not dangerous and should be given their civil rights. This has resulted in allowing dangerously mentally ill persons, who openly threaten, to maintain their freedom until they commit a punishable crime. Unfortunately this is not only late; it very often results in a mass murder. The health system, along with psychology, needs to strike a balance between free speech and public safety."

This fall I had the pleasure of attending the celebration of the 25th Anniversary of The Board of Children, Youth, and Families of the National Academies of Sciences, Engineering, and Medicine. Former APA Congressional Fellow Natacha Blain is the current staff Director, following upon the impressive successes of fellow psychologist Kimber Bogard. Over the years, the Board has developed a number of insightful, interdisciplinary-oriented, cutting-edge reports bringing the best of science to focus upon the needs of our nation's future generations. Equally impressive, has been their visionary conviction regarding the importance of effectively bringing their recommendations to the attention of our nation's policy-makers at the local, regional, and national level. For example, "Young adulthood (spanning the ages of approximately 18-26) is a significant and pivotal time of life…. Any conversation with today's young adults is likely to evoke observations about the stresses and uncertainties they confront. (Their) needs, and the challenges they face, do not receive a great deal of systematic attention in policy and research…." That, "Increasing numbers of evidence-based interventions have proven effective in preventing and treating behavioral disorders in children. However, the adoption of these interventions in the health care system and other systems that affect the lives of children has been slow…." And, "Parents are among the most important people in the lives of young children." Over the years, their insightful strategies have, and are continuing to, make a real difference in the lives of our nation's children. As one keynote speaker envisions, Evidence-base practice is not the destination, it is the start of an important process. [Winston Churchill]. Aloha,

Pat DeLeon, former APA President – Hawaii Psychological Association – December, 2018


Sent from my iPhone

ALOHA - HPA column

“ONE MAN WITH CONVICTION WILL OVERWHELM A HUNDRED WHO HAVE ONLY OPINIONS”

            The 2018 elections will definitely bring a new face and new voice to the U.S. Congress.  More than 100 women are projected to win seats in the House of Representatives; an all-time record with women never having held more than 84 seats in the past.  Many of these victorious candidates campaigned on the need for better health care for all Americans.  They came from a wide variety of backgrounds, from military Veterans to teachers, and many had never run for office before.  On Election Day Veterans won at least 77 House seats, joining 15 others already in the U.S. Senate.  Together, they represent the largest cohort of Veterans in Congress in almost a decade.  For much of the later part of the 20^th century Veterans accounted for more than half of the Members of Congress; their percentage shrinking to less than 20% in recent years.  As The Washington Post noted: “Veterans – trained in teamwork, and perhaps less invested in proving their toughness with public put-downs and posturing – are more inclined to work across the aisle….  (They) sign on to bipartisan legislation more often than Members who have not served in the military.”

            Long time VA visionary and public servant Russell Lemle, along with colleagues Joan Zweben and Joe Ruzek, have been working with the non-profit Veterans Healthcare Policy Institute (VHPI) to ensure that the Veterans Health Administration (VHA) will be strengthened and reformed, and not dismantled and privatized, as some leading political commentators have suggested.  They have produced detailed analyses about the impact of various proposed policies on Veterans, written investigative pieces on mental health Choice options, and placed interdisciplinary-oriented briefs into the official record of Congressional hearings.  They have especially worked to elevate the positive stories of Veterans’ healthcare experiences, with the active support of former heads of various governmental healthcare agencies and a dedicated group of Veterans, healthcare providers, journalists, and activists.  Suzanne Gordon, another VHPI analyst, just published an incisive book, Wounds of War, that illuminates the innovate care throughout the VHA system, devoting eight chapters to mental health.  These efforts are more important than ever as the Administration continues to contemplate outsourcing much of traditional VA healthcare to the private sector, while downsizing VHA facilities.  Russell is increasingly optimistic that their collective voices will be heard by the new Congress.

            Another visionary colleague, Femina Varghese, serves as Associate Editor for the Division 18 journal Psychological Services, where she strives to expose our nation’s public service colleagues to the evolving trends of the future; for example, interprofessional, team-based integrated care and how the unprecedented developments within the technology field will continue to have a major impact upon healthcare.  She was recently awarded $350,000 from the Robert Wood Johnson Foundation (RWJF) for her project “Regional Expansion of Treatment for Addiction in Corrections via Tele-Health: Project REACH.”  Femina, who is at the University of Central Arkansas, and her colleagues, Nickolas Zaller (University of Arkansas for Medical Sciences) and Ben Udochi (Arkansas Department of Community Corrections), are the principal investigators.  Their project will provide counseling services through video conferencing to parolees in rural Arkansas to target risk factors to recidivism.  It was selected as part of the competitive RWJF Interdisciplinary Research Leaders program, which engages both researchers and community partners to strengthen communities towards positive health outcomes.  Counseling psychology doctoral students from the University of Central Arkansas’s APA accredited PhD program will be delivering supervised services through telehealth.  The students are excited to have the experience of providing services to such a marginalized population using up-to-date technology.  Their aspiration is to develop a model for a rural telehealth program to provide treatment for behavioral health disorders in a community corrections office.  They hope that their findings will increase the use of telehealth services to reach correctional populations and thereby provide needed services.

            Nick Cummings served as APA President in 1979 and is well known for his highly accurate, although often quite unpopular, predictions, over the years, regarding the nation’s ever-evolving healthcare environment.  “The terrible massacre in Pittsburg has caused us to focus on anti-Semitism; but this is only the latest in a series of extensive murders by mentally ill persons with so-called ‘honorable’ miss-beliefs.  Having lived to age 94, I remember well the era when mentally ill persons were by law forcibly hospitalized.  There were no such murders then, but the system was much abused.  For example, gay men were regarded as ‘mentally ill’ and were subjected to hospitalization until they ostensibly demonstrated they had become heterosexual.  As a result, the mental hospital system was over-flowing with patients who did not belong there.  Even worse was the subsequent era of Dr. Freeman who purported to ‘cure’ the mentally ill by giving them all a lobotomy.  Mental hospitals lined up mentally ill patients while Freeman performed one prefrontal lobotomy after another using a box of ordinary non-sterilized ice picks, throwing each away after use.  I recall when Freeman bragged he had performed his number 5,000 lobotomy.  Mental hospitals would line up their hapless patients upon his arrival.  Because hospitalized patients did not (could not) commit crimes, the absurd conclusion was reached that mentally ill patients were not dangerous and should be given their civil rights.  This has resulted in allowing dangerously mentally ill persons, who openly threaten, to maintain their freedom until they commit a punishable crime.  Unfortunately this is not only late; it very often results in a mass murder.  The health system, along with psychology, needs to strike a balance between free speech and public safety.”

            This fall I had the pleasure of attending the celebration of the 25^th Anniversary of The Board of Children, Youth, and Families of the National Academies of Sciences, Engineering, and Medicine.  Former APA Congressional Fellow Natacha Blain is the current staff Director, following upon the impressive successes of fellow psychologist Kimber Bogard.  Over the years, the Board has developed a number of insightful, interdisciplinary-oriented, cutting-edge reports bringing the best of science to focus upon the needs of our nation’s future generations.  Equally impressive, has been their visionary conviction regarding the importance of effectively bringing their recommendations to the attention of our nation’s policy-makers at the local, regional, and national level.  For example, “Young adulthood (spanning the ages of approximately 18-26) is a significant and pivotal time of life….  Any conversation with today’s young adults is likely to evoke observations about the stresses and uncertainties they confront.  (Their) needs, and the challenges they face, do not receive a great deal of systematic attention in policy and research….”  That, “Increasing numbers of evidence-based interventions have proven effective in preventing and treating behavioral disorders in children.  However, the adoption of these interventions in the health care system and other systems that affect the lives of children has been slow….”  And, “Parents are among the most important people in the lives of young children.”  Over the years, their insightful strategies have, and are continuing to, make a real difference in the lives of our nation’s children.  As one keynote speaker envisions, Evidence-base practice is not the destination, it is the start of an important process.  [Winston Churchill].  Aloha,

Pat DeLeon, former APA President – Hawaii Psychological Association – December, 2018

THE NATION’S EVER-EVOLVING HEALTHCARE ENVIRONMENT

It is important to appreciate that substantive change always takes time and further, that those who study the evolving currents within our nation's healthcare environment often develop an intuitive sense of how the future will evolve. Nearly two decades ago, the Institute for the Future, supported by the Robert Wood Johnson Foundation, prognosticated what the future of health and health care would be within the decade (i.e., in 2010). Many of their predictions hold true today. It was expected that the nation's population will be older and more ethnically and racially diverse. The burden of disease would shift towards chronic illnesses that stem from our behaviors. Whereas the health care industry had lagged behind other industries in implementing information technologies, this will become a prime catalyst of change. The emergence of new health care providers will also create change. Physicians were described as experiencing little real change in the way they practiced medicine "since the invention of the telephone." "Our health behaviors… influence up to 50 percent of our health status. Although we do not anticipate radical improvements in these health behaviors… the emphasis… on prevention will help us to begin to decrease these harmful behaviors." Perhaps most significantly, "(O)ver the next decade, our view of health will be expanded to encompass mental, social, and spiritual well-being." "Understanding the role of mental factors in health and disease may be the most important contribution of an expanded view of health."

The Agency for Healthcare Research and Quality (AHRQ): At our Uniformed Services University health policy class, Arlene Bierman, Director of the AHRQ Center for Evidence and Practice Improvement, described their exciting efforts to bring up-to-date research findings to the attention of policy makers, practitioners and their professional organizations. Primary care is complex and dynamic in nature, often requiring a team-based approach to meet the needs of patients with behavioral health issues. AHRQ created the Academy for Integrating Behavioral Health and Primary Care as a national resource for healthcare professionals interested in behavioral health and primary care integration. The Academy organizes the knowledge base and research, while providing expert insight on why and how to integrate effectively on a meaningful scale. The Academy Web Portal [https://integrationacademy.ahrq.gov] offers definitions, measures, strategies, lessons learned, and other practical tips for application to the field of integration. Its website features several products for clinicians, researchers, and quality improvement teams such as a lexicon, playbook [https://integrationacademy.ahrq.gov/products/playbook/about-playbook], and resources on opioid use disorder and substance abuse. All of AHRQ's materials are in the public domain and therefore available free of charge.

Divisional Fellows Demonstrating Exceptional Vision: Former Division 42 President (1990) Michael Enright truly appreciated the implications of the changing tides within healthcare. "This is your old pal Ranger Mike checking in from my hacienda in central Mexico. It seems like a lifetime ago that you and I put in the resolution to the Council of Representatives of the APA to create Division 55 of the association -- to endorse prescriptive authority for our colleagues in psychology. As you know, I took a different trail and been practicing as an APRN for the past 20 years. Madre de Dios – 'What a long strange trip it's been.' I still have the official hospital badge that my nurse supervisors fashioned for me that introduced me as 'Dr. Enright, Student Nurse.' Although it is sometimes awkward to explain my dual credentialing, I am so happy that I chose this route for attaining prescribing authority.

"I continue to question the wisdom of our profession in requiring a doctoral level practitioner to earn another Master's degree in order to demonstrate the competency required for prescriptive authority. You recall our many discussions and debates regarding the wisdom of this strategy during the 1990s. In retrospect, I am concerned that this onerous requirement has unintentionally stifled our dream of universal prescriptive authority for psychology. In contrast to the current limited practice of prescribing psychologists, my nurse credential allows me to access a full, unlimited formulary of medications for my patients. In Wyoming, advance practice nurses have the same authority as physicians when writing a prescription. My license also allows me to follow my patients to other states should they need medication when traveling. You might be surprised how often this is necessary. I have 'called' medication for my patients to every state in the union, but Texas, over the course of my career. I do not regret taking the direct route to prescriptive authority and am very thankful to my nursing colleagues for having helped me with the initial training. Notwithstanding my aforementioned critique, I am proud, as I'm sure you are, of my colleagues in the states that have passed prescriptive authority legislation for psychologists (including neighboring Idaho).

"These days you will find me in my office in Wyoming where I continue to practice part time with my primary care partners in our rural multidisciplinary clinic. Today, we are even more inclusive and have added a nutritionist, a podiatrist, a biofeedback office, and yes, even a very progressive chiropractor to our team. Practicing as a psychologist and as a nurse practitioner no longer feels like such an anomaly. When I am not in the office I am usually wandering up a trout stream in the high country above the Red Desert or rambling through a barranca in the Sierra Madre. These peaceful days afford me the time to reflect on how thankful I am to have had the honor of advancing the scope of practice for our profession with wonderful colleagues, especially former President Jack Wiggins with his rural vision. Thank you!"

Another one of psychology's truly unsung visionaries, Randy Phelps, has made a tremendous difference over the past quarter-of-a-century for all of the profession, and especially for our practitioners in private or public service. "I am retiring as APA's senior advisor for health care financing on December 31st, the day before my birthday. I was recruited by Russ Newman in 1994 to assist efforts to get mental health coverage – and psychology -- into the Clinton health care plan, and agreed to close my Houston practice and come aboard for a 2-year stint. I like to joke that I'm now on my 25th year of a 2-year APA contract, and we are still working on access to mental health care for all Americans.

"Over my 25 years at APA, I have had the good fortune to be involved in so many things of great importance to psychology, and to the public we serve. Often, these works were behind the scenes, and not apparent to our members, but were nevertheless critical to the future of our profession. There are many accomplishments I'm proud of. In the late 1990s, I led the creation of the Health and Behavior billing codes for delivering psychological services to those with physical disorders. This was APA's first attempt to get psychologists more fully into integrated care, something we are unfortunately still struggling with today. The Health and Behavior CPT codes were designated to eliminate the problem of having to assign the patient a psychiatric diagnosis just to use psychological methods to help someone with a physical illness like diabetes, for example.

"I began my career in the public sector and am still dedicated to that work. I created the APA's Veteran's Affairs portfolio 20 years ago, including serving on the VA's Committee on Serious Mental Illness, and working with the VA Central Office, many Veterans Service Organizations, and VA's own psychology organizations. I was a co-founder of the annual VA Psychology Leadership Conference, now in its 21st year, and was one of the architects of the Congressional deal that moved psychology into the professional pay category in VA. And it was through this work that I met my wife, Dr. Barbara Van Dahlen, the founder of Give an Hour, which gives free mental health care to service members, Veterans, and their families.

"In recent years, I left my decade-long position as Deputy Executive Director of the APA Practice Directorate and APA Practice Organization, to lead a small team of staff and volunteer psychologists charged with insuring our profession's value and reimbursement levels within the healthcare system. We represent psychology inside the quasi-regulatory system run by Medicare and the AMA's CPT and RUV systems. This has been the most challenging and difficult work I have done in my 40 years as a psychologist, made even harder by confidentiality agreements that prevent our work from coming to light until 1-2 years later. I am proud that over the past five years our team won increases in national payment levels for the psychotherapy codes, and more recently, increases beginning in 2019 for most psychologists who provide psychological and neuropsychological testing.

"This past year for APA's 125th anniversary I was honored with an invitation to write the history of professional practice over the last 25 years. That article, co-authored with my colleagues James Bray and Lisa Kearney, was published in a special edition of the American Psychologist. Much of the profession's journey that we describe in the article is my own journey as well.

"Through it all I've had the pleasure of working with the best and brightest of our discipline. There are far too many to name here, but you know who you are, and I am indebted to each of you. Despite being a Texan, I'm not actually riding off into the sunset. In fact, I will be devoting all of my energy to Give an Hour. Although I will no longer be in a position to make strategy and policy decisions at APA, I am looking forward to watching what our next generation of psychologists will do. Indeed, I will have a front row seat, since our oldest daughter is on her way to becoming one of us." Aloha,

Pat DeLeon, former APA President – Division 42 – November, 2018



Sent from my iPhone

ALOHA - D42 column

THE NATION’S EVER-EVOLVING HEALTHCARE ENVIRONMENT

            It is important to appreciate that substantive change always takes time and further, that those who study the evolving currents within our nation’s healthcare environment often develop an intuitive sense of how the future will evolve.  Nearly two decades ago, the Institute for the Future, supported by the Robert Wood Johnson Foundation, prognosticated what the future of health and health care would be within the decade (i.e., in 2010).  Many of their predictions hold true today.  It was expected that the nation’s population will be older and more ethnically and racially diverse.  The burden of disease would shift towards chronic illnesses that stem from our behaviors.  Whereas the health care industry had lagged behind other industries in implementing information technologies, this will become a prime catalyst of change.  The emergence of new health care providers will also create change.  Physicians were described as experiencing little real change in the way they practiced medicine “since the invention of the telephone.”  “Our health behaviors… influence up to 50 percent of our health status.  Although we do not anticipate radical improvements in these health behaviors… the emphasis… on prevention will help us to begin to decrease these harmful behaviors.”  Perhaps most significantly, “(O)ver the next decade, our view of health will be expanded to encompass mental, social, and spiritual well-being.”  “Understanding the role of mental factors in health and disease may be the most important contribution of an expanded view of health.”

The Agency for Healthcare Research and Quality (AHRQ):  At our Uniformed Services University health policy class, Arlene Bierman, Director of the AHRQ Center for Evidence and Practice Improvement, described their exciting efforts to bring up-to-date research findings to the attention of policy makers, practitioners and their professional organizations.  Primary care is complex and dynamic in nature, often requiring a team-based approach to meet the needs of patients with behavioral health issues.  AHRQ created the Academy for Integrating Behavioral Health and Primary Care as a national resource for healthcare professionals interested in behavioral health and primary care integration.  The Academy organizes the knowledge base and research, while providing expert insight on why and how to integrate effectively on a meaningful scale.  The Academy Web Portal [https://integrationacademy.ahrq.gov] offers definitions, measures, strategies, lessons learned, and other practical tips for application to the field of integration.  Its website features several products for clinicians, researchers, and quality improvement teams such as a lexicon, playbook [https://integrationacademy.ahrq.gov/products/playbook/about-playbook], and resources on opioid use disorder and substance abuse.  All of AHRQ’s materials are in the public domain and therefore available free of charge.

Divisional Fellows Demonstrating Exceptional Vision:  Former Division 42 President (1990) Michael Enright truly appreciated the implications of the changing tides within healthcare.  “This is your old pal Ranger Mike checking in from my hacienda in central Mexico.  It seems like a lifetime ago that you and I put in the resolution to the Council of Representatives of the APA to create Division 55 of the association -- to endorse prescriptive authority for our colleagues in psychology.  As you know, I took a different trail and been practicing as an APRN for the past 20 years.  Madre de Dios – ‘What a long strange trip it’s been.’  I still have the official hospital badge that my nurse supervisors fashioned for me that introduced me as ‘Dr. Enright, Student Nurse.’  Although it is sometimes awkward to explain my dual credentialing, I am so happy that I chose this route for attaining prescribing authority.

“I continue to question the wisdom of our profession in requiring a doctoral level practitioner to earn another Master’s degree in order to demonstrate the competency required for prescriptive authority.  You recall our many discussions and debates regarding the wisdom of this strategy during the 1990s.  In retrospect, I am concerned that this onerous requirement has unintentionally stifled our dream of universal prescriptive authority for psychology.  In contrast to the current limited practice of prescribing psychologists, my nurse credential allows me to access a full, unlimited formulary of medications for my patients.  In Wyoming, advance practice nurses have the same authority as physicians when writing a prescription.  My license also allows me to follow my patients to other states should they need medication when traveling.  You might be surprised how often this is necessary.  I have ‘called’ medication for my patients to every state in the union, but Texas, over the course of my career.  I do not regret taking the direct route to prescriptive authority and am very thankful to my nursing colleagues for having helped me with the initial training.  Notwithstanding my aforementioned critique, I am proud, as I’m sure you are, of my colleagues in the states that have passed prescriptive authority legislation for psychologists (including neighboring Idaho).

“These days you will find me in my office in Wyoming where I continue to practice part time with my primary care partners in our rural multidisciplinary clinic.  Today, we are even more inclusive and have added a nutritionist, a podiatrist, a biofeedback office, and yes, even a very progressive chiropractor to our team.  Practicing as a psychologist and as a nurse practitioner no longer feels like such an anomaly.  When I am not in the office I am usually wandering up a trout stream in the high country above the Red Desert or rambling through a barranca in the Sierra Madre.  These peaceful days afford me the time to reflect on how thankful I am to have had the honor of advancing the scope of practice for our profession with wonderful colleagues, especially former President Jack Wiggins with his rural vision.  Thank you!” 

Another one of psychology’s truly unsung visionaries, Randy Phelps, has made a tremendous difference over the past quarter-of-a-century for all of the profession, and especially for our practitioners in private or public service.  “I am retiring as APA’s senior advisor for health care financing on December 31^st, the day before my birthday.  I was recruited by Russ Newman in 1994 to assist efforts to get mental health coverage – and psychology -- into the Clinton health care plan, and agreed to close my Houston practice and come aboard for a 2-year stint.  I like to joke that I’m now on my 25^th year of a 2-year APA contract, and we are still working on access to mental health care for all Americans.

            “Over my 25 years at APA, I have had the good fortune to be involved in so many things of great importance to psychology, and to the public we serve.  Often, these works were behind the scenes, and not apparent to our members, but were nevertheless critical to the future of our profession.  There are many accomplishments I’m proud of.  In the late 1990s, I led the creation of the Health and Behavior billing codes for delivering psychological services to those with physical disorders.  This was APA’s first attempt to get psychologists more fully into integrated care, something we are unfortunately still struggling with today.  The Health and Behavior CPT codes were designated to eliminate the problem of having to assign the patient a psychiatric diagnosis just to use psychological methods to help someone with a physical illness like diabetes, for example.

            “I began my career in the public sector and am still dedicated to that work.  I created the APA’s Veteran’s Affairs portfolio 20 years ago, including serving on the VA’s Committee on Serious Mental Illness, and working with the VA Central Office, many Veterans Service Organizations, and VA’s own psychology organizations.  I was a co-founder of the annual VA Psychology Leadership Conference, now in its 21^st year, and was one of the architects of the Congressional deal that moved psychology into the professional pay category in VA.  And it was through this work that I met my wife, Dr. Barbara Van Dahlen, the founder of Give an Hour, which gives free mental health care to service members, Veterans, and their families.

            “In recent years, I left my decade-long position as Deputy Executive Director of the APA Practice Directorate and APA Practice Organization, to lead a small team of staff and volunteer psychologists charged with insuring our profession’s value and reimbursement levels within the healthcare system.  We represent psychology inside the quasi-regulatory system run by Medicare and the AMA’s CPT and RUV systems.  This has been the most challenging and difficult work I have done in my 40 years as a psychologist, made even harder by confidentiality agreements that prevent our work from coming to light until 1-2 years later.  I am proud that over the past five years our team won increases in national payment levels for the psychotherapy codes, and more recently, increases beginning in 2019 for most psychologists who provide psychological and neuropsychological testing.

            “This past year for APA’s 125^th anniversary I was honored with an invitation to write the history of professional practice over the last 25 years.  That article, co-authored with my colleagues James Bray and Lisa Kearney, was published in a special edition of the American Psychologist.  Much of the profession’s journey that we describe in the article is my own journey as well.

            “Through it all I’ve had the pleasure of working with the best and brightest of our discipline.  There are far too many to name here, but you know who you are, and I am indebted to each of you.  Despite being a Texan, I’m not actually riding off into the sunset.  In fact, I will be devoting all of my energy to Give an Hour.  Although I will no longer be in a position to make strategy and policy decisions at APA, I am looking forward to watching what our next generation of psychologists will do.  Indeed, I will have a front row seat, since our oldest daughter is on her way to becoming one of us.”  Aloha,

Pat DeLeon, former APA President – Division 42 – November, 2018

AN INTRIGUING PROFESSIONAL JOURNEY

We have been fascinated by the professional careers of those colleagues who have had the opportunity to spend time on Capitol Hill. Sandra Haldane served in our office as an Indian Health Service (IHS) Congressional Fellow, eventually being appointed Chief Nurse of the IHS. She has returned to her original roots as a clinician, serving her Alaskan Native people as an elementary school nurse (Title 1, PK-5th grade, including a special education preschool and school for the deaf), which she loves! We expect that a number of our public service colleagues are traveling in different stages along similar personal and professional journeys, perhaps completely unaware. The unique opportunities provided by public service careers allow for the "value added" benefit of becoming one of the "learned professions."

"At what point(s) in your professional life do you identify as the moment(s) that changed the trajectory of where you thought your career was heading? I imagine that many of us can name several points and people that have influenced our direction. I look back on my now 37 year career as a registered nurse and still can't believe the path I've trod, the luck I've had, and especially the moments that took me in a different direction!

"It was spring of 1991. I was only 10 years into my career as a registered nurse, new to the Commissioned Corps of the USPHS, and working as a staff nurse on the adult medical/surgical floor at the Alaska Native Medical Center (ANMC), then the largest IHS hospital in the country (still the largest but Tribally operated). Out of the blue, I was called to the Nurse Administrator's office and was informed that the IHS nursing leadership had received a call from the office of the late Senator Ted Stevens (R-AK) and they were looking for an Alaskan Native nurse to participate in a forum that the National Institute of Nursing Research (NINR hadn't been designated as an Institute yet) regarding the recruitment and preparation of ethnic minority nurses into nursing research and how to engage more ethnically diverse communities in nursing research. Back then (and I mean way back then) I knew virtually nothing about nursing research, it didn't receive much attention in my bachelor's program. I'll never forget walking into that conference room on the NIH campus and seeing place card after place card all around the room titled Dr. (insert name here). Talk about feeling out of place and way out of my league!

"But shortly after walking in and finding my place I was approached by CAPT Audrey Koertvelyessy, Chief Nurse of the IHS. I was flabbergasted, my stomach now doing more flip-flops! Here I am a bachelor's prepared nurse in a room full of Ph.D. nurses and in the company of the highest ranked nurse in the Indian health system, the system from which I had received care almost my entire life and the system in which I was now working. This became a defining moment in my career. Within the subsequent three years I was doing things I had never dreamed of, things that had never even entered my mind, all because I had crossed paths with the right person, at the right time – Audrey ( CAPT Koertvelyessy). That evening and the next during the research forum, she introduced me to other IHS headquarters' staff and gave me a brief tour of headquarters. I was duly impressed, getting to meet such senior staff. But I returned to Anchorage and my job at ANMC, not really giving much thought to my recent experience or what it meant for me professionally.

"It wasn't long however that I received a second call to the ANMC Nurse Administrator's office and this time with an even more incredible request. A request from the IHS Chief Nurse for an Alaskan Native Nurse to report to the office of the late Senator Daniel K. Inouye (D-Hi) for a six week legislative nurse Fellowship. I was stunned that I was the one being asked to fulfil this request. I'd never been involved in the legislative, policy-setting side of healthcare or nursing. Suffice it to say, the six weeks I spent as the IHS Legislative Nurse Fellow was perhaps the most eye-opening, thought-provoking, and career-impacting points of my career! Another defining moment in my career! During the ensuing six weeks I sat front and center in the office of Senator Inouye, right next to an Air Force nurse officer who was stationed in the office for an entire year! The Department of Defense (DOD) nursing leadership had the where-with-all to know the importance of preparing future nurse leaders and that preparation included a firm understanding and first-hand knowledge of how national healthcare policy is made, how it impacts their constituents, and how federal budgeting and program development occurs at the highest level and then trickles down. As such, the DOD stationed an Air Force, Army, or Navy nurse in the Senator's office every year. Many of these nurses went on to become the Chief Nurse of their respective Uniformed Service or held other very high-ranking assignments in the DOD. Our desks also sat directly across from the office of the Chief of Staff who was the lead on all things health care legislation/policy related. Under his wings we learned that the health care of our people, in my case Alaskan Natives and American Indians, and the constituents of the DOD-our Veterans and Uniformed Service personnel, not to mention our professions, lay in the hands of people who had little to no experience in the health care field. As such, policy makers relied heavily on relationships they had built with professionals out in the field, in their home states, in universities, in professional organizations, in practice settings to help them identify and understand the impact of proposed policy and to develop policy for the greater good.

"It was a daily occurrence in the office of the Senator that we would be invited on a walk. It was these walks that led us to the offices of other legislators and staffers, or to meetings over coffee to discuss the pros and cons of proposed policy or just to keep up the relationship with staffers and leaders on both sides of the isle, working together to formulate plans that would be acceptable to all parties. The other thing we learned was the concept of "the concept" – that is, how to conceptualize. In the legislative arena, things are never black and white, nor are they absolute. We learned the indispensable requirement for establishing and maintaining relationships with the experts in our field. We learned the necessity of calling upon their expertise so as to define all aspects of any given topic. And, we learned the critical element of thinking outside of the box (before thinking outside of the box was even a term). It wasn't good enough to just dream, it was to dream big, dream strategically, and find partners on The Hill to work with on seeing these dreams of legislation come to fruition. What was so profound, however, was the Inouye staff's innate commitment to mentoring and encouraging us fledgling policy-makers. We felt way out of our comfort zone but on a daily basis we were helped to realize what possibilities there were for our futures, what influence we could have on the health of our families and communities, and what impact we could make in our professions and the country. It was never just about the Inouye staff or us; it was about all of us.

"I left Washington, DC and the IHS Legislative Nurse Fellowship on Capitol Hill a changed person, changed nurse, changed citizen. My future as a nurse, my professional life would never be the same. I had caught a mild case of what we humorously call Potomac Fever; a desire to be involved and influential; to remain informed and active in the policy arena; be it local, state, or national. My experience laid the groundwork for the rest of my career. While I loved direct patient care, I recognized the broader impact I could have as a nurse leader. And, with the support, recognition, and influence, not to mention the mentoring I received from Audrey, Senator Inouye, and others who have crossed by path since, I took what I learned and have used it at every step in my subsequent career moves and community involvement.

"It's been 27 years since I left the challenges of working on The Hill but that time is forever engrained upon me and has influenced almost all aspects of my career choices. It taught me to dream and dream big about what I wanted to accomplish; to think outside the box and to look at the greater good, the public's health. I learned to seek out the experts and those who will be impacted, to be aware and involved and not let my profession be driven by others. It taught me the importance of relationships and how to turn a concept into a reality. What I learned on The Hill stayed with me as I traversed all the subsequent positions in my now 37 year career. And while the skills and knowledge gleaned those many years ago were essential for my roles as a Nurse Executive and Chief Nurse of the IHS, they are just as essential in my current role as a school nurse. Not a day goes by that I do not think of what our children need to stay healthy and well, and mine and others' role in achieving that.

"While local, state, or national policy-making might seem nebulous, and dipping into the policy-making arena may be well outside one's comfort zone, I can't stress enough how rewarding and life changing it can be. Whether one chooses to influence locally or on a broader scale at the state or national level, one will never be disappointed; you will know that you have worked to change, for the better, your community and your profession."

Hopefully, Sandra's enthusiasm will encourage several of our early or mid-career colleagues to participate in the APA Congressional Fellowship program. If interested, contact Gabe Twose (gtwose@APA.org). It truly is a life-changing experience. Aloha,

Pat DeLeon, former APA President – Division 18 – November, 2018


Sent from my iPhone

ALOHA - D18 column

AN INTRIGUING PROFESSIONAL JOURNEY

            We have been fascinated by the professional careers of those colleagues who have had the opportunity to spend time on Capitol Hill.  Sandra Haldane served in our office as an Indian Health Service (IHS) Congressional Fellow, eventually being appointed Chief Nurse of the IHS.  She has returned to her original roots as a clinician, serving her Alaskan Native people as an elementary school nurse (Title 1, PK-5^th grade, including a special education preschool and school for the deaf), which she loves!    We expect that a number of our public service colleagues are traveling in different stages along similar personal and professional journeys, perhaps completely unaware.  The unique opportunities provided by public service careers allow for the “value added” benefit of becoming one of the “learned professions.”

            “At what point(s) in your professional life do you identify as the moment(s) that changed the trajectory of where you thought your career was heading?  I imagine that many of us can name several points and people that have influenced our direction.  I look back on my now 37 year career as a registered nurse and still can’t believe the path I’ve trod, the luck I’ve had, and especially the moments that took me in a different direction!

            “It was spring of 1991.  I was only 10 years into my career as a registered nurse, new to the Commissioned Corps of the USPHS, and working as a staff nurse on the adult medical/surgical floor at the Alaska Native Medical Center (ANMC), then the largest IHS hospital in the country (still the largest but Tribally operated).  Out of the blue, I was called to the Nurse Administrator’s office and was informed that the IHS nursing leadership had received a call from the office of the late Senator Ted Stevens (R-AK) and they were looking for an Alaskan Native nurse to participate in a forum that the National Institute of Nursing Research (NINR hadn’t been designated as an Institute yet) regarding the recruitment and preparation of ethnic minority nurses into nursing research and how to engage more ethnically diverse communities in nursing research.  Back then (and I mean way back then) I knew virtually nothing about nursing research, it didn’t receive much attention in my bachelor’s program.  I’ll never forget walking into that conference room on the NIH campus and seeing place card after place card all around the room titled Dr. (insert name here).  Talk about feeling out of place and way out of my league!

            “But shortly after walking in and finding my place I was approached by CAPT Audrey Koertvelyessy, Chief Nurse of the IHS.  I was flabbergasted, my stomach now doing more flip-flops!  Here I am a bachelor’s prepared nurse in a room full of Ph.D. nurses and in the company of the highest ranked nurse in the Indian health system, the system from which I had received care almost my entire life and the system in which I was now working.  This became a defining moment in my career.  Within the subsequent three years I was doing things I had never dreamed of, things that had never even entered my mind, all because I had crossed paths with the right person, at the right time – Audrey ( CAPT Koertvelyessy).  That evening and the next during the research forum, she introduced me to other IHS headquarters’ staff and gave me a brief tour of headquarters.  I was duly impressed, getting to meet such senior staff.  But I returned to Anchorage and my job at ANMC, not really giving much thought to my recent experience or what it meant for me professionally.

            “It wasn’t long however that I received a second call to the ANMC Nurse Administrator’s office and this time with an even more incredible request.  A request from the IHS Chief Nurse for an Alaskan Native Nurse to report to the office of the late Senator Daniel K. Inouye (D-Hi) for a six week legislative nurse Fellowship.  I was stunned that I was the one being asked to fulfil this request.  I’d never been involved in the legislative, policy-setting side of healthcare or nursing.  Suffice it to say, the six weeks I spent as the IHS Legislative Nurse Fellow was perhaps the most eye-opening, thought-provoking, and career-impacting points of my career!  Another defining moment in my career!  During the ensuing six weeks I sat front and center in the office of Senator Inouye, right next to an Air Force nurse officer who was stationed in the office for an entire year!  The Department of Defense (DOD) nursing leadership had the where-with-all to know the importance of preparing future nurse leaders and that preparation included a firm understanding and first-hand knowledge of how national healthcare policy is made, how it impacts their constituents, and how federal budgeting and program development occurs at the highest level and then trickles down.  As such, the DOD stationed an Air Force, Army, or Navy nurse in the Senator’s office every year.  Many of these nurses went on to become the Chief Nurse of their respective Uniformed Service or held other very high-ranking assignments in the DOD.  Our desks also sat directly across from the office of the Chief of Staff who was the lead on all things health care legislation/policy related.  Under his wings we learned that the health care of our people, in my case Alaskan Natives and American Indians, and the constituents of the DOD-our Veterans and Uniformed Service personnel, not to mention our professions, lay in the hands of people who had little to no experience in the health care field.  As such, policy makers relied heavily on relationships they had built with professionals out in the field, in their home states, in universities, in professional organizations, in practice settings to help them identify and understand the impact of proposed policy and to develop policy for the greater good.

            “It was a daily occurrence in the office of the Senator that we would be invited on a walk.  It was these walks that led us to the offices of other legislators and staffers, or to meetings over coffee to discuss the pros and cons of proposed policy or just to keep up the relationship with staffers and leaders on both sides of the isle, working together to formulate plans that would be acceptable to all parties.  The other thing we learned was the concept of “the concept” – that is, how to conceptualize.  In the legislative arena, things are never black and white, nor are they absolute.  We learned the indispensable requirement for establishing and maintaining relationships with the experts in our field.  We learned the necessity of calling upon their expertise so as to define all aspects of any given topic.  And, we learned the critical element of thinking outside of the box (before thinking outside of the box was even a term).  It wasn’t good enough to just dream, it was to dream big, dream strategically, and find partners on The Hill to work with on seeing these dreams of legislation come to fruition.  What was so profound, however, was the Inouye staff’s innate commitment to mentoring and encouraging us fledgling policy-makers.  We felt way out of our comfort zone but on a daily basis we were helped to realize what possibilities there were for our futures, what influence we could have on the health of our families and communities, and what impact we could make in our professions and the country.  It was never just about the Inouye staff or us; it was about all of us.

            “I left Washington, DC and the IHS Legislative Nurse Fellowship on Capitol Hill a changed person, changed nurse, changed citizen.  My future as a nurse, my professional life would never be the same.  I had caught a mild case of what we humorously call Potomac Fever; a desire to be involved and influential; to remain informed and active in the policy arena; be it local, state, or national.  My experience laid the groundwork for the rest of my career.  While I loved direct patient care, I recognized the broader impact I could have as a nurse leader.  And, with the support, recognition, and influence, not to mention the mentoring I received from Audrey, Senator Inouye, and others who have crossed by path since, I took what I learned and have used it at every step in my subsequent career moves and community involvement.

            “It’s been 27 years since I left the challenges of working on The Hill but that time is forever engrained upon me and has influenced almost all aspects of my career choices.  It taught me to dream and dream big about what I wanted to accomplish; to think outside the box and to look at the greater good, the public’s health.  I learned to seek out the experts and those who will be impacted, to be aware and involved and not let my profession be driven by others.  It taught me the importance of relationships and how to turn a concept into a reality.  What I learned on The Hill stayed with me as I traversed all the subsequent positions in my now 37 year career.  And while the skills and knowledge gleaned those many years ago were essential for my roles as a Nurse Executive and Chief Nurse of the IHS, they are just as essential in my current role as a school nurse.  Not a day goes by that I do not think of what our children need to stay healthy and well, and mine and others’ role in achieving that.

            “While local, state, or national policy-making might seem nebulous, and dipping into the policy-making arena may be well outside one’s comfort zone, I can’t stress enough how rewarding and life changing it can be.  Whether one chooses to influence locally or on a broader scale at the state or national level, one will never be disappointed; you will know that you have worked to change, for the better, your community and your profession.”

            Hopefully, Sandra’s enthusiasm will encourage several of our early or mid-career colleagues to participate in the APA Congressional Fellowship program.  If interested, contact Gabe Twose (gtwose@APA.org).   It truly is a life-changing experience.  Aloha,

Pat DeLeon, former APA President – Division 18 – November, 2018

THE RISING TIDES – WAVES OF CHANGE

One of the advantages of serving on the U.S. Senate staff or the APA Board of Directors (especially as President) is that one is systematically exposed to evolving trends within our nation's healthcare environment and the field of psychology. The position essentially forces one to think creatively beyond personal agendas and previous "comfort" levels. One's perspective becomes broader and more integrative – similarities across engaged stakeholders become more evident. A review of this year's Appropriations conference reports, which have been signed into public law, for the Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA) clearly illustrates an increasing Congressional interest in encouraging the development of a wide-range of mental health services, to be provided by various disciplines, and via evolving technological platforms. More specifically:

· The HHS Behavioral Health Workforce Education and Training account includes support for Master's level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health nurse practitioners, occupational therapists, psychology doctoral interns, and behavioral health paraprofessionals. HRSA should continue to encourage all eligible health professions to apply.
· $150,000,000 is provided for the Certified Community Behavioral Health Clinics program under SAMHSA.
· The VA is directed to work with the Office of Personnel Management (OPM) to create an Occupational Series for Licensed Professional Mental Health Counselors and Marriage and Family Therapists and to create a staffing plan to fill such open positions and assess shortages.
· The Secretary of the VA is urged to work with facilities that have not yet implemented VA's final rule granting full practice authority to advanced practice registered nurses to ensure quick implementation. VA is directed to accelerate the rollout of competitive pay for physician assistants and develop a plan on how to better utilize the Health Professional Scholarship Program and Education Debt Reduction Program.
· Telehealth – HHS: $1,000,000 is included through the Telehealth Network grant program to fund awards that use evidence-based practices that promote school safety and individual health, mental health, and well-being. The grants should provide assessment and referrals for health, mental health, or substance use disorders services to students who may be struggling with behavioral or mental health issues. In addition, grants should provide training and support to teachers, school counselors, administrative staff, school resource officers, and other relevant staffs to identify, refer, and intervene to help students experiencing mental health needs or who are considering harming themselves or others.
· VA: $30,000,000 is provided above the budget request for telehealth capabilities. This additional funding should be used to further expand telehealth capacity and services in rural and remote areas. The VA is directed to provide a report to the Committees on Appropriations of both Houses of Congress specifying measures the Department is taking to expand telehealth and telemental health capacities in rural areas, particularly regions with limited broadband access. The report should also include information on any ongoing collaboration between VA and other Federal agencies to target remote and rural areas to maximize coverage.

"I am very pleased with the extent to which APA has been increasingly active in terms of legislative activities and developing policies that affect, not only psychologists but all citizens of this country. At our March 2018 meeting, the Council of Representatives voted to support pursuing accreditation of Master's level programs in psychology in areas where APA already accredits. In addition, Council voted to adopt as APA policy the Guidelines on Core Learning Goals for Master's Degree Graduates in Psychology. A Task Force was formed and has been charged to outline a plan by which APA could pursue development of an accreditation system for Master's programs in health service areas (clinical, counseling, school, etc.) of psychology.

"On a national level, the APA and the APA Practice Organization government relations staff worked throughout the year with Members of Congress to help shape legislation to address the opioid epidemic. The bill (the 'SUPPORT for Patients and Communities Act') passed both the House (by a vote of 393 to 8) and Senate (with a vote of 98 to 1). The SUPPORT Act makes helpful policy changes spanning several federal agencies, including the Centers for Medicare and Medicaid Services and the Department of Health and Human Services.

"Finally, APA has acknowledged that the most effective way to have the maximum impact legislatively is to have 'One APA,' a unified advocacy model. In 2017, APA began exploring options for modernizing its structure to create a 'One APA' model in which two distinct components (a 501(c3) organization and a 501(c6) organization) seamlessly address the full range of member expectations and the needs of the discipline and profession related to advocacy and member benefits. To guide this transformation, APA committed to maintain, at a minimum, the current budget levels for all advocacy and government relations programs across practice, science, education and public interest. The Work Group recognized the importance of both long-term goals and the need for agility in carrying out the advocacy priorities in a fast-paced political environment. Also critical to the Work Group was that the process emphasizes psychology as a whole, while ensuring that the various sub-fields have a voice and representation in the prioritization process. I am genuinely excited about the future and have decided that the time has arrived, both personally and professionally, for me to run for APA President" [Jennifer Kelly, APA Recording Secretary].

The Global Perspective: In 2002, the World Health Organization (WHO) released its report Prevention and Promotion in Mental Health in which it reiterated that health is: "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Thus, in order to attain health, improvement of the mental health of individuals is essential." The report noted that mental disorders are growing and are responsible for a high degree of burden. "It is essential that effective preventive and promotional measurers be taken in mental health to reduce the impact of mental disorders on the individual and society." WHO estimated that about 450 million people suffer from mental disorders; one person in every four individuals will be affected at some stage of their life. By 2020, it was estimated that depression will become the second leading cause for disease burden. This burden extends into the community and society as a whole, having far-reaching economic and social consequences.

"Natural or human-made disasters and conflicts generate a huge number of psychosocial and mental health problems that cause enormous strains on society. These conflicts tend to be in the poorest regions of the world and the associated burden of mental health problems leads to severe financial strains on the already impoverished monetary situation in these countries," There were vast differences between countries in available mental health resources. The concept of what constitutes mental illness varies amongst cultures based on local beliefs and practices. WHO called on professional associations and prevention research groups to become mobilized to undertake research in the development of evidence-based effective strategies, which might well differ across countries and cultures.

More than a decade and a half later, former APA President Alan Kazdin: "There is now a well-documented crisis in mental health in the United States and world-wide. Stated generally, the vast majority of individuals in need of mental health services receive absolutely nothing. Just considering the U.S., we know that approximately 70% of individuals in need of mental health services receive nothing; i.e., no formal treatment of any kind by a health practitioner. In clinical psychology, there is a massive outpouring of evidence-based treatment, quibbles about treatment as usual (often just as effective as evidence-based treatments), what meta-analyses of therapy really show or do not show, why therapy works, can we bridge the research practice gap, and so on. All are arguably important and classic questions. All are arguably missing the point. Most people receive no treatment.

"Among the many problems is the dominant model of treatment delivery. As a profession in clinical practice and graduate training, we are committed primarily, almost exclusively, to one-to-one individual therapy with a trained mental health professional. The professions not only advocate that, they are very interested in protecting that. We have considerable evidence now that lay individuals (heresy to mention but they are not licensed) can administer treatment effectively to treat individuals with mental disorders. And we now have many models of delivery that can reach people in need but are not at all part of training among the mental health professions and do not seem to be of much interest.

"Individual psychotherapies of all kinds, task force reports about the problem, various 'resolutions' and consensus statements continue to ignore the problem. What is psychology doing to reduce the burdens of mental illness and to reach people in need of services? I am not implying that we are not doing wonderful things. But treatments, evidence-based or not, just are not getting to people in need. The situation is even worse among subpopulations (individuals of an ethnic minority, children and adolescents, single parents, elderly individuals, victims of domestic violence, and the list goes on). What are we doing to reach people in need and to reduce the burdens of mental illness? The professions could do more. Our effectiveness in addressing each of these can be measured and measurement is our (psychology's) specialty. Clinical psychology does not seem to show interest in moving away from treatment models that do not reach people. Could we turn some or more of our mental health profession to problems I have outlined here? Our psychotherapy research and debates aside, this is so much it seems like 'an emperor's new clothes' situation. Imagine if we turned our research and clinical turrets to people in need on a scale that not only made a difference to individuals but to the burdens experienced by their families and society at large. Perhaps I am expecting too much from our discipline. Public Health is probably more relevant."

We recently discussed this seeming "disconnect" between the potential contributions of psychology (and psychiatric mental health nursing) and the documented worldwide need for mental health services, with Dale Smith, Professor of Military Medicine & History at the Uniformed Services University (USU). Dale pointed out that for WHO to issue such a report, international scholars and public health officials had undoubtedly been seriously discussing this situation for at least a decade, if not longer. He asked: Was our collective failure to act a reflection of our lack of political will? That is, do we really know what we should do, but we have consciously decided not to expend the financial, professional, and political capital necessary to successfully engage? Or, in the alternative, is this the type of complex situation where we genuinely do not know how to address such a compelling need? He suggested that if it were the latter, perhaps the next step should be the development of a comprehensive research strategy exploring what efforts have been attempted in the past and why have they not been successful. Significant change always takes time; often more than one would anticipate.

Unique Interprofessional Training Experience: At USU, psychology and nursing graduate students can join with fourth-year medical students in participating in an intensive five-day field training exercise in the mystical country of Pandakar (located in the woods of rural Pennsylvania). "Bushmaster gave us a unique opportunity to hone our skills in a deployed setting in three primary roles. In the Combat Stress Control (CSC) team role, we immersed ourselves in the Pandakar setting and visited each platoon to conduct a Unit Needs Assessment (UNA). This required us to engage with each platoon's security team, obtain buy-in from their leadership, and build rapport with their unit members to learn how we could best help them. In the Combat and Operational Stress Control (COSC) clinic role, we established an independent clinic in Pandakar and prepared to accept all types of combat stress casualties for treatment or medevac. Finally, in our 'real world' Bushmaster role, we engaged countless participants (to include moulage artists, actors, faculty, and military leadership) to build morale with assistance from our mascot, Panda Pauli. As future leaders and providers in mental health, Bushmaster gave us a glimpse into our deployed role that would be impossible in any other educational setting. Not only did it help prepare us for future clinical care, but it also gave us an opportunity to educate other students on the importance of supporting our troops' mental health and morale needs downrange" [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student]. Aloha,

Pat DeLeon, former APA President – Division 29 – November, 2018


Sent from my iPhone

ALOHA - D29

THE RISING TIDES – WAVES OF CHANGE

            One of the advantages of serving on the U.S. Senate staff or the APA Board of Directors (especially as President) is that one is systematically exposed to evolving trends within our nation’s healthcare environment and the field of psychology.  The position essentially forces one to think creatively beyond personal agendas and previous “comfort” levels.  One’s perspective becomes broader and more integrative – similarities across engaged stakeholders become more evident.  A review of this year’s Appropriations conference reports, which have been signed into public law, for the Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA) clearly illustrates an increasing Congressional interest in encouraging the development of a wide-range of mental health services, to be provided by various disciplines, and via evolving technological platforms.  More specifically:

·         The HHS Behavioral Health Workforce Education and Training account includes support for Master’s level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health nurse practitioners, occupational therapists, psychology doctoral interns, and behavioral health paraprofessionals.  HRSA should continue to encourage all eligible health professions to apply.

·         $150,000,000 is provided for the Certified Community Behavioral Health Clinics program under SAMHSA.

·         The VA is directed to work with the Office of Personnel Management (OPM) to create an Occupational Series for Licensed Professional Mental Health Counselors and Marriage and Family Therapists and to create a staffing plan to fill such open positions and assess shortages.

·         The Secretary of the VA is urged to work with facilities that have not yet implemented VA’s final rule granting full practice authority to advanced practice registered nurses to ensure quick implementation.  VA is directed to accelerate the rollout of competitive pay for physician assistants and develop a plan on how to better utilize the Health Professional Scholarship Program and Education Debt Reduction Program.

·         Telehealth – HHS: $1,000,000 is included through the Telehealth Network grant program to fund awards that use evidence-based practices that promote school safety and individual health, mental health, and well-being.  The grants should provide assessment and referrals for health, mental health, or substance use disorders services to students who may be struggling with behavioral or mental health issues.  In addition, grants should provide training and support to teachers, school counselors, administrative staff, school resource officers, and other relevant staffs to identify, refer, and intervene to help students experiencing mental health needs or who are considering harming themselves or others.

·         VA: $30,000,000 is provided above the budget request for telehealth capabilities.  This additional funding should be used to further expand telehealth capacity and services in rural and remote areas.  The VA is directed to provide a report to the Committees on Appropriations of both Houses of Congress specifying measures the Department is taking to expand telehealth and telemental health capacities in rural areas, particularly regions with limited broadband access.  The report should also include information on any ongoing collaboration between VA and other Federal agencies to target remote and rural areas to maximize coverage.

“I am very pleased with the extent to which APA has been increasingly active in terms of legislative activities and developing policies that affect, not only psychologists but all citizens of this country.  At our March 2018 meeting, the Council of Representatives voted to support pursuing accreditation of Master’s level programs in psychology in areas where APA already accredits.  In addition, Council voted to adopt as APA policy the Guidelines on Core Learning Goals for Master’s Degree Graduates in Psychology.  A Task Force was formed and has been charged to outline a plan by which APA could pursue development of an accreditation system for Master’s programs in health service areas (clinical, counseling, school, etc.) of psychology.

“On a national level, the APA and the APA Practice Organization government relations staff worked throughout the year with Members of Congress to help shape legislation to address the opioid epidemic.  The bill (the ‘SUPPORT for Patients and Communities Act’) passed both the House (by a vote of 393 to 8) and Senate (with a vote of 98 to 1).  The SUPPORT Act makes helpful policy changes spanning several federal agencies, including the Centers for Medicare and Medicaid Services and the Department of Health and Human Services.

            “Finally, APA has acknowledged that the most effective way to have the maximum impact legislatively is to have ‘One APA,’ a unified advocacy model.  In 2017, APA began exploring options for modernizing its structure to create a ‘One APA’ model in which two distinct components (a 501(c3) organization and a 501(c6) organization) seamlessly address the full range of member expectations and the needs of the discipline and profession related to advocacy and member benefits.  To guide this transformation, APA committed to maintain, at a minimum, the current budget levels for all advocacy and government relations programs across practice, science, education and public interest.  The Work Group recognized the importance of both long-term goals and the need for agility in carrying out the advocacy priorities in a fast-paced political environment.  Also critical to the Work Group was that the process emphasizes psychology as a whole, while ensuring that the various sub-fields have a voice and representation in the prioritization process.  I am genuinely excited about the future and have decided that the time has arrived, both personally and professionally, for me to run for APA President” [Jennifer Kelly, APA Recording Secretary].

The Global Perspective:  In 2002, the World Health Organization (WHO) released its report Prevention and Promotion in Mental Health in which it reiterated that health is: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Thus, in order to attain health, improvement of the mental health of individuals is essential.”  The report noted that mental disorders are growing and are responsible for a high degree of burden.  “It is essential that effective preventive and promotional measurers be taken in mental health to reduce the impact of mental disorders on the individual and society.”  WHO estimated that about 450 million people suffer from mental disorders; one person in every four individuals will be affected at some stage of their life.  By 2020, it was estimated that depression will become the second leading cause for disease burden.  This burden extends into the community and society as a whole, having far-reaching economic and social consequences.

“Natural or human-made disasters and conflicts generate a huge number of psychosocial and mental health problems that cause enormous strains on society.  These conflicts tend to be in the poorest regions of the world and the associated burden of mental health problems leads to severe financial strains on the already impoverished monetary situation in these countries,”  There were vast differences between countries in available mental health resources.  The concept of what constitutes mental illness varies amongst cultures based on local beliefs and practices.  WHO called on professional associations and prevention research groups to become mobilized to undertake research in the development of evidence-based effective strategies, which might well differ across countries and cultures.

            More than a decade and a half later, former APA President Alan Kazdin: “There is now a well-documented crisis in mental health in the United States and world-wide.  Stated generally, the vast majority of individuals in need of mental health services receive absolutely nothing.  Just considering the U.S., we know that approximately 70% of individuals in need of mental health services receive nothing; i.e., no formal treatment of any kind by a health practitioner.  In clinical psychology, there is a massive outpouring of evidence-based treatment, quibbles about treatment as usual (often just as effective as evidence-based treatments), what meta-analyses of therapy really show or do not show, why therapy works, can we bridge the research practice gap, and so on.  All are arguably important and classic questions.  All are arguably missing the point.  Most people receive no treatment.

            “Among the many problems is the dominant model of treatment delivery.  As a profession in clinical practice and graduate training, we are committed primarily, almost exclusively, to one-to-one individual therapy with a trained mental health professional.  The professions not only advocate that, they are very interested in protecting that.  We have considerable evidence now that lay individuals (heresy to mention but they are not licensed) can administer treatment effectively to treat individuals with mental disorders.  And we now have many models of delivery that can reach people in need but are not at all part of training among the mental health professions and do not seem to be of much interest.

            “Individual psychotherapies of all kinds, task force reports about the problem, various ‘resolutions’ and consensus statements continue to ignore the problem.  What is psychology doing to reduce the burdens of mental illness and to reach people in need of services?  I am not implying that we are not doing wonderful things.  But treatments, evidence-based or not, just are not getting to people in need.  The situation is even worse among subpopulations (individuals of an ethnic minority, children and adolescents, single parents, elderly individuals, victims of domestic violence, and the list goes on).  What are we doing to reach people in need and to reduce the burdens of mental illness?  The professions could do more.  Our effectiveness in addressing each of these can be measured and measurement is our (psychology’s) specialty.  Clinical psychology does not seem to show interest in moving away from treatment models that do not reach people.  Could we turn some or more of our mental health profession to problems I have outlined here?  Our psychotherapy research and debates aside, this is so much it seems like ‘an emperor’s new clothes’ situation.  Imagine if we turned our research and clinical turrets to people in need on a scale that not only made a difference to individuals but to the burdens experienced by their families and society at large.  Perhaps I am expecting too much from our discipline.  Public Health is probably more relevant.”

            We recently discussed this seeming “disconnect” between the potential contributions of psychology (and psychiatric mental health nursing) and the documented worldwide need for mental health services, with Dale Smith, Professor of Military Medicine & History at the Uniformed Services University (USU).  Dale pointed out that for WHO to issue such a report, international scholars and public health officials had undoubtedly been seriously discussing this situation for at least a decade, if not longer.  He asked: Was our collective failure to act a reflection of our lack of political will?  That is, do we really know what we should do, but we have consciously decided not to expend the financial, professional, and political capital necessary to successfully engage?  Or, in the alternative, is this the type of complex situation where we genuinely do not know how to address such a compelling need?  He suggested that if it were the latter, perhaps the next step should be the development of a comprehensive research strategy exploring what efforts have been attempted in the past and why have they not been successful.  Significant change always takes time; often more than one would anticipate.

            Unique Interprofessional Training Experience:  At USU, psychology and nursing graduate students can join with fourth-year medical students in participating in an intensive five-day field training exercise in the mystical country of Pandakar (located in the woods of rural Pennsylvania).  “Bushmaster gave us a unique opportunity to hone our skills in a deployed setting in three primary roles.  In the Combat Stress Control (CSC) team role, we immersed ourselves in the Pandakar setting and visited each platoon to conduct a Unit Needs Assessment (UNA).  This required us to engage with each platoon’s security team, obtain buy-in from their leadership, and build rapport with their unit members to learn how we could best help them.  In the Combat and Operational Stress Control (COSC) clinic role, we established an independent clinic in Pandakar and prepared to accept all types of combat stress casualties for treatment or medevac.  Finally, in our ‘real world’ Bushmaster role, we engaged countless participants (to include moulage artists, actors, faculty, and military leadership) to build morale with assistance from our mascot, Panda Pauli.  As future leaders and providers in mental health, Bushmaster gave us a glimpse into our deployed role that would be impossible in any other educational setting.  Not only did it help prepare us for future clinical care, but it also gave us an opportunity to educate other students on the importance of supporting our troops’ mental health and morale needs downrange” [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].  Aloha,

Pat DeLeon, former APA President – Division 29 – November, 2018

ODE TO JOY

Earlier this year our visionary leader Ron Fox left us after a short heroic battle with cancer. A number of us had the opportunity to visit with him during those final weeks and were extraordinarily moved by his continuing passion for the many contributions that psychology can make to our nation. The establishment of Division 55 was but one of Ron's many "gifts" to the field. Former APA President Tony Puente was able to personally present him with a special Presidential Citation and they discussed APA's renewed organizational efforts to become more effective legislatively.

"One of the unique opportunities that has arisen with the difficulties APA has encountered in recent years is that of rebuilding and transforming itself. With the unusual demands and chaos in the public arena, especially with political and social issues, APA's leadership took the special step of reconsidering the role of advocacy within the organization. APA is comprised of two organizations – one for psychology (c3) and one for psychologists (c6). The former is what most of us know about APA and what APA has been for 125 years. The latter is primarily comprised of the APA Practice Organization, devoted to the profession of psychology. After much research, thought and deliberation it was evident to us that the role and funding of the APA Practice Organization had run its course based on the foundation of its pioneering vision emerging during the late 1980s. This year the Council of Representatives, after much vetting, decided to pass an historic agenda item empowering a new vision for all aspects of the profession of psychologists – not just clinicians; but scientists, professors, public interest as well as applied psychologists. This new entity, APA Psychological Services, will now begin a robust and exhaustive advocacy program that is well funded, integrated and essentially limitless. The Association has recently put out a call for nominees to be part of the inaugural Advocacy Coordinating Committee which will be convened on January 1, 2019. This group will begin to study and prioritize APA's advocacy agenda. I am pleased to report that Ron was very supportive of this evolution and highly engaged during our discussions" (Tony Puente).

One of Ron's special attributes was his capacity to serve as a mentor for decades of colleagues, including a number of us serving with him on the Board of Directors and the Division. "Ron, who was instrumental in creating the School of Professional Psychology (SOPP) at Wright State University, valued deeply the education and training of psychologists. Consequently it is no surprise that SOPP was awarded the first grant by the APA Committee for the Advancement of Professional Psychology (CAPP) to develop a curriculum for the training that would be needed to support prescriptive authority. As a faculty member during that time I had the wonderful opportunity to work on this grant, together with our Dean for Academic Affairs Alan Barclay. As we all know, Ron was never at a loss for words, usually capturing in the most succinct way the essence of the issue. And so it was when it came to psychologists and prescribing. In one of our conversations, as we discussed the most recent vocal opposition by other psychologists to the idea, Ron commented how psychologists certainly were capable of learning! So, not to even explore the idea – yes, he saw they were objecting to the idea – in his view was being 'anti-intellectual!' Our profession has lost not only a visionary, but a voice of wisdom. Aloha" (Kathy McNamara).

"I spoke with Ron by phone shortly before he passed. I was aware that he had many calls and visits earlier. We talked for well over an hour, maybe two. Judy scheduled the time. Given his illness, I was surprised how much time he was able to talk. But I was so glad to be able to speak with him. He talked about his memories of our time working together at Wright State (1983-1992). I listened.

"Among other things, he reminisced about our times at SOPP and the many accomplishments. We had both come to Wright State after working as psychologists within Schools of Medicine (Meharry and Ohio State). The circumstances at Wright State provided an extraordinary opportunity for both of us professionally and for psychology as a profession. For example, the structure of the School of Professional Psychology existed on an equal level with the University's Schools of Medicine and Nursing. This meant that the Dean of the School had a direct reporting relationship to the University Provost and as well sometimes to the University President. This had important implications for the School's budget since it would not compete with the numerous departments (including the Psychology Department in the Liberal Arts College) and other programs within the University for allocations and controls. Among other things this added tremendous status to Psychology as an independent health profession, (i.e., not subordinate to psychiatry).

"Ron spoke proudly about the many students who trained at SOPP and who went on to successful careers. He was very proud of our success in identifying talented minority trainees as well as their career successes. He was also proud of our successes in obtaining federal grants for the School from NIMH, the HHS Health Care Opportunity grant program, and the Maternal and Child Health Bureau which at the time was unique for PsyD programs. We were also successful in obtaining support from the Ohio Department of Mental Health and the Department of Health Office of Minority Health. I remember him saying at the end: 'Looking back on it all Rod, we did great work there….' That meant a lot to me…" (Rod Hammond).

One of Ron's most enduring efforts was to significantly increase the governance and policy involvement of psychology's female and ethnic minority members. As has often been the case, Ron was decades ahead of his colleagues. Jacque Gray, a Choctaw and Cherokee descendent, has been working with her Native American colleagues to get as many Early Career Native Americans elected and appointed to various APA Boards, Committees, and Task Forces. As an Associate Editor of the Division 18 journal Psychological Services, she has been outstanding in bringing their unique perspective to the attention of public service psychologists – including those serving within the military, VA, and Indian Health Service. "The Society of Indian Psychologists' Commentary on the APA Ethical Principles of Psychologists and Code of Conduct was published and has contributed to APA's understanding of ethics in a cultural context. In 2015, there were only 10 Native American Fellows of APA and rarely were any indigenous psychologists recognized for their accomplishments by APA. Since that time we have increased the number of APA Fellows by 50% and in 2018, 12 APA awards went to indigenous psychologists. Division 45 now has the Trimble Horvat Awards for a senior psychologist and a student to acknowledge contributions to Native or Indigenous Psychology. In 2016, Division 45 Presidential initiatives focused upon contributions to psychology by Native Americans. These accomplishments include Networking Theory developed by Carolyn Atteneave, Maslow taking his hierarchy of needs from the Blackfeet/Blood tribes of Montana and Canada, Jung going to the Hopi to learn about dream interpretation, Erickson learning about child rearing practices from the Lakota, and Sherif and Sherif taking over a project from three Native American graduate students at Robbers' Cave and never mentioning them. It is important for these contributions to be acknowledged and taught in psychology courses" (Jacque Gray)."

In our judgment, over the past several years, APA Board of Directors' member Beth Rom-Rymer has probably done more than any other single individual to revitalize Ron's vision for prescriptive authority (RxP). The Illinois Psychological Association's stunning 2014 legislative RxP success, under her leadership, after nearly a decade of inactivity at the state level, is simply monumental. Beth truly appreciates the importance of Ron's commitment to the next generation and I have been pleased to serve as a reviewer for her American Psychological Foundation (APF) RxP scholarship submissions, as well as participate in her various Windy City networking dinners, convening those actively seeking clinical psychopharmacology training and those who are committed to providing training for prescribing psychologists. These often include colleagues from the county, state, and federal sectors. Because she has made it a priority to participate on the Boards of mental health and educational institutions, in Illinois, major stakeholders have jumped in to support the training of prescribing psychologists. Most recently, Beth is partnering with AMITA Health, which is the third largest health system in Illinois, to create an innovative program of Graduate Psychology Assistantships in The Advancement of RxP Training.

"AMITA Health, with nine hospitals, 80 clinics and outpatient facilities, and more than 3,000 hospital-affiliated physicians, is expanding its residency training opportunities for prescribing psychologists by hiring two advanced graduate students, per year, at 20 hours/week, with significant stipends, to assist the organization of the residency training in the state-required medical rotations; assist in broadening of the residency training to accommodate the needs of psychology interns and post-docs; assist in the creation of a statewide residency program model that prepares its trainees for a superior level of prescriptive practice; assist in the lobbying efforts to expand the scope of practice of the Illinois Prescriptive Authority statute; and, to become involved in a comprehensive research program that will assess the effectiveness of prescribing psychologists, an oft-requested and much needed initiative.

"Another hospital system, based in the neighboring state of Indiana, is excited about the opportunity to integrate prescribing psychologist training into its existing medical residency program. This system is considering offering a substantial salary to psychology residents, while they pursue their medical residency program and take their place on its faculty roster. [Recall that in 1993 Mike Murphy was successful in amending the Indiana psychology statute to include prescribing; notwithstanding, his Hoosier colleagues have yet to develop an effective implementation plan.] Other new rotation training sites, under discussion, include the Illinois state and county correctional systems; a community-based (and internationally recognized) healthcare clinic for, primarily, LBGTQ residents; the largest and oldest social service organization in Illinois; and a trauma center in one of Chicago's internationally renowned medical institutions" (Beth Rom-Rymer).

Another Exciting Training Program Opening Up: "Idaho State University Department of Pharmacy is finalizing the curriculum of their two year, brick and mortar, Psychopharmacology Master's program. We are in the final stages of interviewing candidates for the director of training position. The plan is to accept students for the 2019-2020 academic year. We continue to be very interested in serving as a military post-doctoral training site and are working to expand our DOD outreach. Great things are happening!" (Page Haviland). Aloha, (German poet, playwright, and historian Friedrich Schiller, 1785).

Pat DeLeon, former APA President – Division 55 – October, 2018



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