IF A FREE SOCIETY CANNOT HELP THE MANY WHO ARE POOR

   Visionary Leaders:  Having the opportunity to spend time with the psychology and advanced practice nursing graduate students at the Uniformed Services University (USU) reinforces my appreciation for their passionate interest in learning the most up-to-date clinical skills.  Reflecting upon the history and probable future of psychology's quest for prescriptive authority (RxP), Fernanda De Oliveira (1^st Lt, USAF) and 2017 APA President Tony Puente proffered that those setting standards for APA accredited internships should facilitate the development of regular interprofessional seminars specifically focusing upon the potential use of psychotropic medications (pros- and cons-) for the patient populations being served.  They further called for the establishment of specialty RxP post-doctoral experiences (e.g., with children or the elderly).

The APA Ad Hoc Task Force on Psychopharmacology was established by the Council of Representatives in 1990 and chaired by Michael Smyer, with Tony serving as a member.  They concluded: "(T)he contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment."  They proposed three levels of training for allpracticing psychologists.  The first was rudimentary understanding of the use and limitations of psychopharmacological intervention.  The second was a mid-level but more in depth understanding including specific application and interaction between psychoactive medicines and mental disorders; e.g., what types of medications might have best impact on what types of depression.  Finally, the third level is what today is called prescription authority which entails both classroom and didactic training.  Psychology's RxP journey began in the Department of Defense with Navy Commander John Sexton and then-Lt. Commander Morgan Sammons being the first graduates of the PDP in 1994.  We would be veryinterested in learning whether any members of the Division have participated in interprofessional RxP seminars as envisioned by the Task Force.  We would expect that nursing and pharmacy would be the most receptive to such collaboration.

When the APA Council began considering RxP in the 1990s, a conscious decision was made to conceptualize the development of this new clinical skill at the post-doctoral level.  Last year, after two decades, the decision was made to relook at the timing of the educational requirements.  One of our most visionary colleagues, Beth Rom-Rymer, who was absolutely critical in Illinois enacting their RxP legislation in 2014, recently hosted her fourth Chicago evening soiree for those committed to advancing the agenda.  Beth has long supported providing the necessary didactic knowledge as early as possible in one's training:

"We had our biggest crowd, yet, for our Fourth Biannual Prescriptive Authority Networking Dinner, at my home, with over 100 people.  We had two distinguished keynote speakers: Arthur Evans, our APA CEO, and Danny Carlat, the first psychiatrist, of whom I'm aware, to publicly support RxP for psychologists.  Danny began to speak out, in our favor, in the late 1990's.  Arthur talked about the importance of strengthening the voice of APA: advocating for the science underlying our psychological principles; increasing opportunities for psychologists in integrated care; advocating for RxP for appropriately trained psychologists; advocating for psychologists in their relationships with managed care; advocating for those individuals in our society who do not have a voice but profoundly suffer from societal injustice.

"In 2010, Danny had written a blog, entitled, Psychologists prescribing is the best thing that can happen to psychiatry.  In part, he said: 'Psychiatry has boxed itself into a tiny corner of medicine called 'Psychopharmacology.'  It's a silly way to practice our craft, because the essence of what we do is to understand the mind and to help people live better lives.  Drugs are effective but only one of the tools available to us, and we have largely ceded psychotherapy to psychologists and social workers.  The result is a fragmentation of care….  As the safety data gradually accrues, I predict that psychologists will attain prescriptive privileges in most states over the next 10-20 years.  We saw the same pattern in the 1970's with Nurse Practitioners – psychiatrists and other physicians engaged in bitter turf wars initially, arguing that they didn't have enough training, but large scale health services research studies eventually demonstrated that NPs operated competently and safely, and now they are accepted as independent practitioners in most states…."  Saturday night, Danny reaffirmed his commitment to the state by state pursuit of RxP.  Since we had representatives from the states of Iowa, Ohio, Connecticut, and Virginia, the prescribing psychology advocates will collaborate with him as they move forward.

"There was a significant diversity of community partners that was represented at the Networking Dinner.  No legislative initiative succeeds without the active support of the larger community.  I recognized the indefatigable efforts of a number of our local healthcare systems.  These outstanding and visionary leaders committed their time, their energy, and their expertise, to create a series of rotation experiences for prescribing psychology trainees that will continue into the foreseeable future.  As we neared the end of our prepared program, I asked all of the 12 Psychology graduate students to come to the front of the room and introduce themselves to the group.  Two of the student leaders talked about why they are choosing to take joint degrees in Clinical Psychopharmacology along with their doctoral degrees in Psychology.  Several Early Career Psychologists introduced themselves, explaining why they are taking the training to become Prescribing Psychologists.  The event lasted almost until midnight.  There was a strong feeling of accomplishment in how we have progressed in the implementation of our statute and enthusiasm for the prominent roles that prescribing psychologists will take in repairing a faltering mental health system.

American Samoa – Federal Responsibility:  Under the leadership of Dean Carol Romano, former Chief Nurse Officer for the U.S. Public Health Service, USU nursing graduate students have begun clinical placements in American Samoa.  Located in the South Pacific, midway between Hawaii and New Zealand, this site was chosen in 1872 as a coaling station for the U.S. Navy.  After the attack on Pearl Harbor on December 7, 1941, naval activity there increased significantly.  It is a U.S. territory, covering seven islands and atolls.  Its population approximates 55,500 with a land mass of 76.8 square miles, slightly more than Washington, DC.  It is noted for having the highest rate of military enlistment of any U.S. state or territory.  With an extreme shortage of health professionals health disparities are rampant.  "It cannot save the few who are rich" [President John F. Kennedy, 1961].  Aloha,

Pat DeLeon, former APA President – Division 19 – February, 2018

 

 

Sent from my iPhone

Div 19 column

IF A FREE SOCIETY CANNOT HELP THE MANY WHO ARE POOR,

            Visionary Leaders:  Having the opportunity to spend time with the psychology and advanced practice nursing graduate students at the Uniformed Services University (USU) reinforces my appreciation for their passionate interest in learning the most up-to-date clinical skills.  Reflecting upon the history and probable future of psychology’s quest for prescriptive authority (RxP), Fernanda De Oliveira (1^st Lt, USAF) and 2017 APA President Tony Puente proffered that those setting standards for APA accredited internships should facilitate the development of regular interprofessional seminars specifically focusing upon the potential use of psychotropic medications (pros- and cons-) for the patient populations being served.  They further called for the establishment of specialty RxP post-doctoral experiences (e.g., with children or the elderly).

The APA Ad Hoc Task Force on Psychopharmacology was established by the Council of Representatives in 1990 and chaired by Michael Smyer, with Tony serving as a member.  They concluded: “(T)he contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment.”  They proposed three levels of training for all practicing psychologists.  The first was rudimentary understanding of the use and limitations of psychopharmacological intervention.  The second was a mid-level but more in depth understanding including specific application and interaction between psychoactive medicines and mental disorders; e.g., what types of medications might have best impact on what types of depression.  Finally, the third level is what today is called prescription authority which entails both classroom and didactic training.  Psychology’s RxP journey began in the Department of Defense with Navy Commander John Sexton and then-Lt. Commander Morgan Sammons being the first graduates of the PDP in 1994.  We would be very interested in learning whether any members of the Division have participated in interprofessional RxP seminars as envisioned by the Task Force.  We would expect that nursing and pharmacy would be the most receptive to such collaboration.

When the APA Council began considering RxP in the 1990s, a conscious decision was made to conceptualize the development of this new clinical skill at the post-doctoral level.  Last year, after two decades, the decision was made to relook at the timing of the educational requirements.  One of our most visionary colleagues, Beth Rom-Rymer, who was absolutely critical in Illinois enacting their RxP legislation in 2014, recently hosted her fourth Chicago evening soiree for those committed to advancing the agenda.  Beth has long supported providing the necessary didactic knowledge as early as possible in one’s training:

“We had our biggest crowd, yet, for our Fourth Biannual Prescriptive Authority Networking Dinner, at my home, with over 100 people.  We had two distinguished keynote speakers: Arthur Evans, our APA CEO, and Danny Carlat, the first psychiatrist, of whom I’m aware, to publicly support RxP for psychologists.  Danny began to speak out, in our favor, in the late 1990’s.  Arthur talked about the importance of strengthening the voice of APA: advocating for the science underlying our psychological principles; increasing opportunities for psychologists in integrated care; advocating for RxP for appropriately trained psychologists; advocating for psychologists in their relationships with managed care; advocating for those individuals in our society who do not have a voice but profoundly suffer from societal injustice.

“In 2010, Danny had written a blog, entitled, Psychologists prescribing is the best thing that can happen to psychiatry.  In part, he said: ‘Psychiatry has boxed itself into a tiny corner of medicine called ‘Psychopharmacology.’  It’s a silly way to practice our craft, because the essence of what we do is to understand the mind and to help people live better lives.  Drugs are effective but only one of the tools available to us, and we have largely ceded psychotherapy to psychologists and social workers.  The result is a fragmentation of care….  As the safety data gradually accrues, I predict that psychologists will attain prescriptive privileges in most states over the next 10-20 years.  We saw the same pattern in the 1970’s with Nurse Practitioners – psychiatrists and other physicians engaged in bitter turf wars initially, arguing that they didn’t have enough training, but large scale health services research studies eventually demonstrated that NPs operated competently and safely, and now they are accepted as independent practitioners in most states….”  Saturday night, Danny reaffirmed his commitment to the state by state pursuit of RxP.  Since we had representatives from the states of Iowa, Ohio, Connecticut, and Virginia, the prescribing psychology advocates will collaborate with him as they move forward.

“There was a significant diversity of community partners that was represented at the Networking Dinner.  No legislative initiative succeeds without the active support of the larger community.  I recognized the indefatigable efforts of a number of our local healthcare systems.  These outstanding and visionary leaders committed their time, their energy, and their expertise, to create a series of rotation experiences for prescribing psychology trainees that will continue into the foreseeable future.  As we neared the end of our prepared program, I asked all of the 12 Psychology graduate students to come to the front of the room and introduce themselves to the group.  Two of the student leaders talked about why they are choosing to take joint degrees in Clinical Psychopharmacology along with their doctoral degrees in Psychology.  Several Early Career Psychologists introduced themselves, explaining why they are taking the training to become Prescribing Psychologists.  The event lasted almost until midnight.  There was a strong feeling of accomplishment in how we have progressed in the implementation of our statute and enthusiasm for the prominent roles that prescribing psychologists will take in repairing a faltering mental health system.

American Samoa – Federal Responsibility:  Under the leadership of Dean Carol Romano, former Chief Nurse Officer for the U.S. Public Health Service, USU nursing graduate students have begun clinical placements in American Samoa.  Located in the South Pacific, midway between Hawaii and New Zealand, this site was chosen in 1872 as a coaling station for the U.S. Navy.  After the attack on Pearl Harbor on December 7, 1941, naval activity there increased significantly.  It is a U.S. territory, covering seven islands and atolls.  Its population approximates 55,500 with a land mass of 76.8 square miles, slightly more than Washington, DC.  It is noted for having the highest rate of military enlistment of any U.S. state or territory.  With an extreme shortage of health professionals health disparities are rampant.  “It cannot save the few who are rich” [President John F. Kennedy, 1961].  Aloha,

Pat DeLeon, former APA President – Division 19 – February, 2018

 

 

NEVER DOUBT THAT A SMALL GROUP OF THOUGHTFUL, COMMITTED CITIZENS CAN CHANGE THE WORLD

 The very last event which APA President Tony Puente presided over was to personally present the Presidential Citation to former Division 29 President Ron Fox.  "On the closing of the American Psychological Association's 125^th anniversary, I, Antonio E. Puente, as President of our venerable society bestow upon Ronald E. Fox this APA Presidential citation on December 31, 2017.  From humble beginnings to being President of our great association, Ron Fox has been driven with a vision of making our world a better place through making the profession of psychology a central change agent.  His long and illustrious career has spanned several decades and various settings including as a clinician, a professor, and an advocate for the profession of psychology.  Starting early in his career, Dr. Fox stood firmly for ethnic-minorities, for women, and for the poor, when such advocacy was considered unimportant.

            "Within APA, he has held numerous governance positions from committee member to being President, and a trustee of the Insurance Trust.  Dr. Fox has been a pioneer in so many venues that it is impossible to list them all.  But here are some important illustrations: key in establishing the APA Practice Directorate, Division 29 (Psychotherapy), Division 55 (Psychopharmacology), and the Association of Psychology Postdoctoral and Internship Centers (APPIC).  He advocated in Ohio for the founding of one of the first Doctor of Psychology programs in the U.S.  Dr. Fox was instrumental in establishing one of the first psychology licensing boards in the U.S. (Ohio).  In addition, he is considered the 'grandfather' for prescription authority in psychology.

            "Ron Fox has been a calm, steady, and reasoned voice for all of psychology for almost half a century.  For his efforts, his resiliency, his vision, and the many results that have made the profession of psychology what it is today, on this last day of APA's 125^th anniversary, let it be known that Ronald E. Fox is presented this APA Presidential Citation."

            Prescriptive Authority (RxP):  From the very beginning, Ron Fox has been a visionary leader in psychology's quest for prescriptive authority (RxP).  Michael Schwarzchild was one of the first colleagues to respond to Ron's call.  Although the State of Connecticut was not initially successful, CPA President Anne Klee reports they have once again returned to this important policy agenda.  Former CPA President and RxP committee chair Barbara Bunk: "I am writing with surprising but good news re the RxP effort in Connecticut.  Our Department of Public Health (DPH) has recently informed CPA that our request for review of our scope of practice to include prescriptive authority for appropriately trained psychologists has been accepted.  DPH is now forming a Committee to review and evaluate the request, and to make subsequent recommendations to the Public Health Committee of the Connecticut General Assembly for the 2018 Legislative Session.  The Committee is comprised of the six healthcare organizations that submitted impact statements regarding our request; each organization gets two seats on the Committee, as do we (CPA).  Notably, the Connecticut Psychiatric Society did not appropriately submit, though the DPH Commissioner can indeed appoint additional Committee members if he so chooses – which he subsequently decided to do.

"The six organizations were CTAPRNS – Connecticut Advanced Practice Nurse Society; CCACP – Connecticut Council of Child and Adolescent Psychiatry; CCAAP – Connecticut Chapter American Association of Pediatrics; CHA – Connecticut Hospital Association; CNA – Connecticut Nurses' Association; and CSMS – Connecticut State Medical Society.  The Committee is scheduled to convene two or three times after Thanksgiving."  Anne: "CPA has now had three review meetings with our DPH.  At the table were various medical groups.  As expected, they brought up issues of quality and safety.  They made mention to an article about psychologists not prescribing with the underserved as expected in New Mexico.  We are well represented by Barbara, Sharif Okasha, and David Greenfield.  Sharif spoke directly to the underlying issue of access.  He and his father operate an established mental health practice in the New London region.  For two years they have attempted (unsuccessfully) to recruit a psychiatrist or advanced practice nurse to join their practice.  On a personal level, he is very interested in pursuing his masters in psychopharmacology in order to continue working with an underserved area of the state."

            The States of Hawaii and Oregon have the unique experience of having their earlier RxP legislation vetoed by their Governors.  This year Mental Health America of Hawaii listed Prescriptive Authority for Advanced Trained Medical Psychologists (RxP) as its first Access To Care Advocacy Priority.  Kelly Harnick, HPA RxP Chair: "Hawaii is determined.  Fortitude and an unwavering commitment best describes the nature of our RxP Committee.  The Aloha State truly is filled with Aloha in our hearts for our communities.  In Maui country, which includes the islands of Maui, Molokai, and Lana'i, we have an estimated 41-43% psychiatrist shortage.  This is unacceptable for our communities that need access to care.  RxP was re-invigorated in 2015 when the previous Speaker of the House introduced House Bill 1072, after two community advocates and myself met with him in a little coffee shop in Central Maui.  Amazing how an entire movement can ignite over a cup of coffee.  At first, being very green at advocacy, I was shocked that the Speaker even agreed to meet with us.  Politics occurred and our beloved HB 1072 made it through every hurdle until the last 30 seconds of the legislative session of 2016.  Today, we soldier on.  We now have HB 2734 introduced yesterday by the Health and Human Services Chair, Rep. Mizuno.  Our goal is steadfast, and I am beyond grateful for my Committee and their dedication to getting RxP passed for our patients.

            "Hawaii is obviously a bit different than other states because we are an island state.  If you live on a neighbor island you can't just drive to the big city, you have to take a flight.  This means that if you need care that is unavailable, you have to somehow find a way to fly over to Honolulu in order to get the care you need.  As the RxP Chair living on Maui, this is unacceptable for our community.  The legislature opened last week Wednesday, and we are going to work harder than ever before to finally get the RxP bill passed for the people of Hawaii.

"To get a bill passed, it is very important to understand the parliamentary procedures in your state legislature.  It is also very important to empower the people on your committee that are looking up to you for leadership.  It can feel quite pressured because when it comes down to it, you know that you are responsible for advocating for a bill that could save lives.  As the RxP Chair, I always remind myself when it's very easy to get wrapped up in the noise of politics and power, why we are doing this in the first place -- because there are people suffering, going without care.  Our suicide rates are amongst the highest in the country.  Most people would be shocked by learning that.  A common myth is that we simply live in paradise so what is there to be depressed about?  However, psychopathology such as clinical depression, bipolar disorders, anxiety disorders, and PTSD to name a few, don't discriminate even if coconut Palm trees are swaying in the trade winds.  The people of Hawaii are not immune to needing both integrated psychological and psychopharmacological care because they live in 'paradise.'

"Prescribing Medical Psychologists have a value system and clinical approach that the patients are absolutely yearning for: to work with a Doctor who knows them well while engaging in therapy, as well as one who encompasses the medical expertise being able to prescribe medication safely, as well as taper them off medication.  One of the myths and arguments of the opposition that bothers me the most is that RxP is about wanting to prescribe more pills.  It simply is not!

"As a psychologist, our training is very special.  We not only are astute on understanding the therapeutic relationship and the healing power it has; but also therapists with the additional medical knowledge that a prescribing medical psychologist has.  I believe it intimidates the opposition because patients want this kind of treatment from a Doctor they feel truly cares and actually knows them well.  Here in Hawaii, we are now beginning to gear up again, working towards getting this RxP bill through the legislature for yet another time, and as we've heard many times before "If we don't stop we will win" [Louisiana's Jim Quillin].  Hawaii will not stop and we will win for our very special island communities.  As the RxP Chair, I personally will not stop and I feel grateful to have a Committee that is as dedicated as any Chair could ask for."

            Investing in Our Future:  I have just completed two terms of service on the Board on Children, Youth, and Families of the National Academy of Medicine (NAM).  This has been an exhilarating experience, working with dedicated colleagues from a broad range of disciplines, addressing issues directly impacting the wellbeing of our nation's children and their families.  Many of these are fundamental to President Obama's landmark Patient Protection and Affordable Care Act, with its emphasis upon prevention, wellness, and population-oriented approaches to healthcare.  According, it was perhaps surprising to realize, in retrospect, that many of the absolutely critical issues raised during these discussions are ones that previously I only might have superficially contemplated – emphasizing the intellectual limitation of working within comfortable, although isolated, "professional silos."  Psychology is especially fortunate that former APA Congressional Fellow Natacha Blain currently serves as Director for the Board, having recently taken over from another visionary psychologist Kimber Bogard.

            Last year the Board, in conjunction with the National Academies of Science, Engineering, and Medicine, released its consensus study report Promoting the Educational Success of Children and Youth Learning English.  A long-time friend and colleague, Ruby Takanishi, served as Chair of that Committee.  Ruby was formerly President and CEO of the Foundation for Child Development.  She has also served as Director of the APA Office of Scientific Affairs, as well as Executive Director of the Carnegie Council on Adolescent Development.  Highlights:

            Educating Dual language learners and English learners effectively is a national challenge with consequences both for individuals and for American society.  Despite their linguistic, cognitive, and social potential, many English learners – who account for more than 9 percent of enrollment in grades K-12 – are struggling to meet the requirements for academic success, and their prospects for success in post-secondary education and in the workforce are jeopardized as a result.  A defining characteristic of these two groups is their demographic diversity.  They are members of every major racial/ethnic group and include both U.S.- and foreign-born youth.  Most come from Latin America and Asia, with Mexico being their leading country of origin.  Relative to other U.S. children, they are far more likely to live in poverty and in two-parent families with low levels of education.  Nevertheless, those that become proficient in both a home or primary language and English are likely to reap benefits in cognitive, social, and emotional development and may also be protected from brain decline at older ages.  In addition, the cultures, languages, and experiences of English learners are highly diverse and constitute assets for their development, as well as for the nation.

            Both society at large and many educational and health professionals hold competing views about whether dual language learning should be supported early in a child's development and later in school.  Some believe that learning two languages early in life is burdensome; while others believe that young children are "hardwired" to learn one or more languages easily and that nothing needs to be done to promote their language development.  Scientific evidence clearly points to a universal, underlying human capacity to learn two languages as easily as one.  And, the available evidence is mixed as to whether there is a critical period for learning a second language.  Research shows that it can take from five to seven years for students to learn the English necessary for participation in a school's curriculum without further linguistic support.  Native language revitalization is an urgent matter for Native Americans communities. Some, however, unfortunately see this as being in direct conflict with school's efforts to promote English.

It is important to appreciate the long-term consequences for the nation of the reality that a high educational achievement and attainment gap exists between English learners and their monolingual peers.  For example, the reading achievement gap is 36 points at the 4^th -grade level and 44 points at the 8^th -grade level.  The high school graduation rate comparison is 63% -- far lower than the rate for students living in low-income families at 75% -- and the overall national rate of 82%.  Language lies at the center of all human development!  "Indeed, it's the only thing that ever has [Margaret Mead]."  Aloha,

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

 

 

Sent from my iPhone

D29 February column

“NEVER DOUBT THAT A SMALL GROUP OF THOUGHTFUL, COMMITTED CITIZENS CAN CHANGE THE WORLD”

            The very last event which APA President Tony Puente presided over was to personally present the Presidential Citation to former Division 29 President Ron Fox.  “On the closing of the American Psychological Association’s 125^th anniversary, I, Antonio E. Puente, as President of our venerable society bestow upon Ronald E. Fox this APA Presidential citation on December 31, 2017.  From humble beginnings to being President of our great association, Ron Fox has been driven with a vision of making our world a better place through making the profession of psychology a central change agent.  His long and illustrious career has spanned several decades and various settings including as a clinician, a professor, and an advocate for the profession of psychology.  Starting early in his career, Dr. Fox stood firmly for ethnic-minorities, for women, and for the poor, when such advocacy was considered unimportant.

            “Within APA, he has held numerous governance positions from committee member to being President, and a trustee of the Insurance Trust.  Dr. Fox has been a pioneer in so many venues that it is impossible to list them all.  But here are some important illustrations: key in establishing the APA Practice Directorate, Division 29 (Psychotherapy), Division 55 (Psychopharmacology), and the Association of Psychology Postdoctoral and Internship Centers (APPIC).  He advocated in Ohio for the founding of one of the first Doctor of Psychology programs in the U.S.  Dr. Fox was instrumental in establishing one of the first psychology licensing boards in the U.S. (Ohio).  In addition, he is considered the ‘grandfather’ for prescription authority in psychology.

            “Ron Fox has been a calm, steady, and reasoned voice for all of psychology for almost half a century.  For his efforts, his resiliency, his vision, and the many results that have made the profession of psychology what it is today, on this last day of APA’s 125^th anniversary, let it be known that Ronald E. Fox is presented this APA Presidential Citation.”

            Prescriptive Authority (RxP):  From the very beginning, Ron Fox has been a visionary leader in psychology’s quest for prescriptive authority (RxP).  Michael Schwarzchild was one of the first colleagues to respond to Ron’s call.  Although the State of Connecticut was not initially successful, CPA President Anne Klee reports they have once again returned to this important policy agenda.  Former CPA President and RxP committee chair Barbara Bunk: “I am writing with surprising but good news re the RxP effort in Connecticut.  Our Department of Public Health (DPH) has recently informed CPA that our request for review of our scope of practice to include prescriptive authority for appropriately trained psychologists has been accepted.  DPH is now forming a Committee to review and evaluate the request, and to make subsequent recommendations to the Public Health Committee of the Connecticut General Assembly for the 2018 Legislative Session.  The Committee is comprised of the six healthcare organizations that submitted impact statements regarding our request; each organization gets two seats on the Committee, as do we (CPA).  Notably, the Connecticut Psychiatric Society did not appropriately submit, though the DPH Commissioner can indeed appoint additional Committee members if he so chooses – which he subsequently decided to do.

“The six organizations were CTAPRNS – Connecticut Advanced Practice Nurse Society; CCACP – Connecticut Council of Child and Adolescent Psychiatry; CCAAP – Connecticut Chapter American Association of Pediatrics; CHA – Connecticut Hospital Association; CNA – Connecticut Nurses’ Association; and CSMS – Connecticut State Medical Society.  The Committee is scheduled to convene two or three times after Thanksgiving.”  Anne: “CPA has now had three review meetings with our DPH.  At the table were various medical groups.  As expected, they brought up issues of quality and safety.  They made mention to an article about psychologists not prescribing with the underserved as expected in New Mexico.  We are well represented by Barbara, Sharif Okasha, and David Greenfield.  Sharif spoke directly to the underlying issue of access.  He and his father operate an established mental health practice in the New London region.  For two years they have attempted (unsuccessfully) to recruit a psychiatrist or advanced practice nurse to join their practice.  On a personal level, he is very interested in pursuing his masters in psychopharmacology in order to continue working with an underserved area of the state.”

            The States of Hawaii and Oregon have the unique experience of having their earlier RxP legislation vetoed by their Governors.  This year Mental Health America of Hawaii listed Prescriptive Authority for Advanced Trained Medical Psychologists (RxP) as its first Access To Care Advocacy Priority.  Kelly Harnick, HPA RxP Chair: “Hawaii is determined.  Fortitude and an unwavering commitment best describes the nature of our RxP Committee.  The Aloha State truly is filled with Aloha in our hearts for our communities.  In Maui country, which includes the islands of Maui, Molokai, and Lana’i, we have an estimated 41-43% psychiatrist shortage.  This is unacceptable for our communities that need access to care.  RxP was re-invigorated in 2015 when the previous Speaker of the House introduced House Bill 1072, after two community advocates and myself met with him in a little coffee shop in Central Maui.  Amazing how an entire movement can ignite over a cup of coffee.  At first, being very green at advocacy, I was shocked that the Speaker even agreed to meet with us.  Politics occurred and our beloved HB 1072 made it through every hurdle until the last 30 seconds of the legislative session of 2016.  Today, we soldier on.  We now have HB 2734 introduced yesterday by the Health and Human Services Chair, Rep. Mizuno.  Our goal is steadfast, and I am beyond grateful for my Committee and their dedication to getting RxP passed for our patients.

            “Hawaii is obviously a bit different than other states because we are an island state.  If you live on a neighbor island you can’t just drive to the big city, you have to take a flight.  This means that if you need care that is unavailable, you have to somehow find a way to fly over to Honolulu in order to get the care you need.  As the RxP Chair living on Maui, this is unacceptable for our community.  The legislature opened last week Wednesday, and we are going to work harder than ever before to finally get the RxP bill passed for the people of Hawaii.

“To get a bill passed, it is very important to understand the parliamentary procedures in your state legislature.  It is also very important to empower the people on your committee that are looking up to you for leadership.  It can feel quite pressured because when it comes down to it, you know that you are responsible for advocating for a bill that could save lives.  As the RxP Chair, I always remind myself when it’s very easy to get wrapped up in the noise of politics and power, why we are doing this in the first place -- because there are people suffering, going without care.  Our suicide rates are amongst the highest in the country.  Most people would be shocked by learning that.  A common myth is that we simply live in paradise so what is there to be depressed about?  However, psychopathology such as clinical depression, bipolar disorders, anxiety disorders, and PTSD to name a few, don’t discriminate even if coconut Palm trees are swaying in the trade winds.  The people of Hawaii are not immune to needing both integrated psychological and psychopharmacological care because they live in ‘paradise.’

“Prescribing Medical Psychologists have a value system and clinical approach that the patients are absolutely yearning for: to work with a Doctor who knows them well while engaging in therapy, as well as one who encompasses the medical expertise being able to prescribe medication safely, as well as taper them off medication.  One of the myths and arguments of the opposition that bothers me the most is that RxP is about wanting to prescribe more pills.  It simply is not!

“As a psychologist, our training is very special.  We not only are astute on understanding the therapeutic relationship and the healing power it has; but also therapists with the additional medical knowledge that a prescribing medical psychologist has.  I believe it intimidates the opposition because patients want this kind of treatment from a Doctor they feel truly cares and actually knows them well.  Here in Hawaii, we are now beginning to gear up again, working towards getting this RxP bill through the legislature for yet another time, and as we’ve heard many times before “If we don’t stop we will win” [Louisiana’s Jim Quillin].  Hawaii will not stop and we will win for our very special island communities.  As the RxP Chair, I personally will not stop and I feel grateful to have a Committee that is as dedicated as any Chair could ask for.”

            Investing in Our Future:  I have just completed two terms of service on the Board on Children, Youth, and Families of the National Academy of Medicine (NAM).  This has been an exhilarating experience, working with dedicated colleagues from a broad range of disciplines, addressing issues directly impacting the wellbeing of our nation’s children and their families.  Many of these are fundamental to President Obama’s landmark Patient Protection and Affordable Care Act, with its emphasis upon prevention, wellness, and population-oriented approaches to healthcare.  According, it was perhaps surprising to realize, in retrospect, that many of the absolutely critical issues raised during these discussions are ones that previously I only might have superficially contemplated – emphasizing the intellectual limitation of working within comfortable, although isolated, “professional silos.”  Psychology is especially fortunate that former APA Congressional Fellow Natacha Blain currently serves as Director for the Board, having recently taken over from another visionary psychologist Kimber Bogard.

            Last year the Board, in conjunction with the National Academies of Science, Engineering, and Medicine, released its consensus study report Promoting the Educational Success of Children and Youth Learning English.  A long-time friend and colleague, Ruby Takanishi, served as Chair of that Committee.  Ruby was formerly President and CEO of the Foundation for Child Development.  She has also served as Director of the APA Office of Scientific Affairs, as well as Executive Director of the Carnegie Council on Adolescent Development.  Highlights:

            Educating Dual language learners and English learners effectively is a national challenge with consequences both for individuals and for American society.  Despite their linguistic, cognitive, and social potential, many English learners – who account for more than 9 percent of enrollment in grades K-12 – are struggling to meet the requirements for academic success, and their prospects for success in post-secondary education and in the workforce are jeopardized as a result.  A defining characteristic of these two groups is their demographic diversity.  They are members of every major racial/ethnic group and include both U.S.- and foreign-born youth.  Most come from Latin America and Asia, with Mexico being their leading country of origin.  Relative to other U.S. children, they are far more likely to live in poverty and in two-parent families with low levels of education.  Nevertheless, those that become proficient in both a home or primary language and English are likely to reap benefits in cognitive, social, and emotional development and may also be protected from brain decline at older ages.  In addition, the cultures, languages, and experiences of English learners are highly diverse and constitute assets for their development, as well as for the nation.

            Both society at large and many educational and health professionals hold competing views about whether dual language learning should be supported early in a child’s development and later in school.  Some believe that learning two languages early in life is burdensome; while others believe that young children are “hardwired” to learn one or more languages easily and that nothing needs to be done to promote their language development.  Scientific evidence clearly points to a universal, underlying human capacity to learn two languages as easily as one.  And, the available evidence is mixed as to whether there is a critical period for learning a second language.  Research shows that it can take from five to seven years for students to learn the English necessary for participation in a school’s curriculum without further linguistic support.  Native language revitalization is an urgent matter for Native Americans communities. Some, however, unfortunately see this as being in direct conflict with school’s efforts to promote English.

It is important to appreciate the long-term consequences for the nation of the reality that a high educational achievement and attainment gap exists between English learners and their monolingual peers.  For example, the reading achievement gap is 36 points at the 4^th -grade level and 44 points at the 8^th -grade level.  The high school graduation rate comparison is 63% -- far lower than the rate for students living in low-income families at 75% -- and the overall national rate of 82%.  Language lies at the center of all human development!  “Indeed, it’s the only thing that ever has [Margaret Mead].”  Aloha,

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