EXCITING CHALLENGES FOR THE NEXT GENERATION

             Psychopharmacology (RxP):  In response to the steadily growing interest in psychopharmacology among our profession's next generation of leaders, and especially those students currently in graduate school, APA is seeking public comment on the proposed modifications to the 2009 RxP model Curriculum, model Designation Criteria, and model Legislation pursuant to a Task Force recommendation.  The Task Force was chaired by Ronald Brown.  It had been approved and subsequently convened by BEA, BPA, and CAPP in 2017, holding an-in person meeting at the end of that year.  Their 2018 recommendations, if approved as APA policy, would make clear that it would be appropriate to provide the didactic portion of the psychopharmacology training during graduate school.  Of historical interest, in 1997 APAGS adopted a formal resolution of support for RxP.

            This year the American Psychological Foundation (APF) issued a call for submissions for the Beth Rom-Rymer Scholarship program which will provide up to nine scholarships to support both graduate students and practicing licensed psychologists to complete their RxP training.  This is in addition to the APF Walter Katkovsky research grants supporting research on the general topic of combining psychotherapy and psychoactive medications, where the medication is an adjunct to psychotherapy and not the primary intervention.  Nearly 30 applications were received for Beth's award, clearly reflecting growing enthusiasm for RxP which her efforts, and especially the successful Illinois legislation, have generated within the field.  We would be pleased to learn of interprofessional efforts conducted by State Associations and individual psychologists integrating the expertise of our colleagues in nursing and clinical pharmacy in the training of our next generation.  As a profession, we seem to under-appreciate the significance of the fact that those seeking mental and behavioral health care remain the same individual, regardless of which professional discipline they ultimately chose to work with.  Remaining in isolated professional silos would seem to be counterproductive at best.

The Exciting Advent of Telehealth:  With the ever increasing sophistication occurring within the communications field and the steadily declining cost of the technology, not to mention the ease with which the younger generation relates to this development, there can be little doubt that the future of health care will become increasingly reliant upon its utilization.  The Departments of Veterans Affairs and Defense have been on the cutting edge of utilizing telehealth (e.g., telepsychology) and have had outstanding results, with mental health being a major focus.  Colleagues report that their younger clients often prefer utilizing this technology to in-person encounters.  The quality of care appears to be equivalent.  For those in the private sector, licensure mobility is a major issue which must be addressed.  Under the visionary leadership of Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB), the APA Council of Representatives endorsed in principle their Psychology Interjurisdictional Compact (PSYPACT), a joint initiative with APA and The Trust, during our Denver convention.  The proposed "E-Passport" would allow the provision of psychological services by qualified licensed psychologists via electronic means across jurisdictional boundaries, without additional licensure in the jurisdiction in which the client was physically present when receiving services.  Three states have already endorsed the Compact with similar efforts underway within the Advanced Practice Nursing (APRN) community.  Steve reports that at least seven states must affirmatively enact the Compact legislation in order for psychology to establish a meaningful presence in this new and evolving environment.  Is your State Association affirmatively addressing this critical issue?  Aloha,

Pat DeLeon, former APA President – Division 31 – March, 2018

 

Sent from my iPhone

ALOHA - Div 31

EXCITING CHALLENGES FOR THE NEXT GENERATION

            Psychopharmacology (RxP):  In response to the steadily growing interest in psychopharmacology among our profession’s next generation of leaders, and especially those students currently in graduate school, APA is seeking public comment on the proposed modifications to the 2009 RxP model Curriculum, model Designation Criteria, and model Legislation pursuant to a Task Force recommendation.  The Task Force was chaired by Ronald Brown.  It had been approved and subsequently convened by BEA, BPA, and CAPP in 2017, holding an-in person meeting at the end of that year.  Their 2018 recommendations, if approved as APA policy, would make clear that it would be appropriate to provide the didactic portion of the psychopharmacology training during graduate school.  Of historical interest, in 1997 APAGS adopted a formal resolution of support for RxP.

            This year the American Psychological Foundation (APF) issued a call for submissions for the Beth Rom-Rymer Scholarship program which will provide up to nine scholarships to support both graduate students and practicing licensed psychologists to complete their RxP training.  This is in addition to the APF Walter Katkovsky research grants supporting research on the general topic of combining psychotherapy and psychoactive medications, where the medication is an adjunct to psychotherapy and not the primary intervention.  Nearly 30 applications were received for Beth’s award, clearly reflecting growing enthusiasm for RxP which her efforts, and especially the successful Illinois legislation, have generated within the field.  We would be pleased to learn of interprofessional efforts conducted by State Associations and individual psychologists integrating the expertise of our colleagues in nursing and clinical pharmacy in the training of our next generation.  As a profession, we seem to under-appreciate the significance of the fact that those seeking mental and behavioral health care remain the same individual, regardless of which professional discipline they ultimately chose to work with.  Remaining in isolated professional silos would seem to be counterproductive at best.

The Exciting Advent of Telehealth:  With the ever increasing sophistication occurring within the communications field and the steadily declining cost of the technology, not to mention the ease with which the younger generation relates to this development, there can be little doubt that the future of health care will become increasingly reliant upon its utilization.  The Departments of Veterans Affairs and Defense have been on the cutting edge of utilizing telehealth (e.g., telepsychology) and have had outstanding results, with mental health being a major focus.  Colleagues report that their younger clients often prefer utilizing this technology to in-person encounters.  The quality of care appears to be equivalent.  For those in the private sector, licensure mobility is a major issue which must be addressed.  Under the visionary leadership of Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB), the APA Council of Representatives endorsed in principle their Psychology Interjurisdictional Compact (PSYPACT), a joint initiative with APA and The Trust, during our Denver convention.  The proposed “E-Passport” would allow the provision of psychological services by qualified licensed psychologists via electronic means across jurisdictional boundaries, without additional licensure in the jurisdiction in which the client was physically present when receiving services.  Three states have already endorsed the Compact with similar efforts underway within the Advanced Practice Nursing (APRN) community.  Steve reports that at least seven states must affirmatively enact the Compact legislation in order for psychology to establish a meaningful presence in this new and evolving environment.  Is your State Association affirmatively addressing this critical issue?  Aloha,

Pat DeLeon, former APA President – Division 31 – March, 2018

 

IT IS MY TIME TO GIVE BACK, SINCE SO MANY HAVE GIVEN TO ME

In November 1984, at the Hawaii Psychological Association (HPA) annual convention, U.S. Senator Daniel K. Inouye urged the membership to seek prescriptive authority (RxP): "When you have obtained this statutory authority… you will be an autonomous profession and your clients will be well-served."  In 1990, the APA Council of Representatives established its Task Force on Prescriptive Authority, chaired by Michael Smyer, and on which APA Past President Tony Puente served.  The task force concluded: "practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge.  The contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment."

Having grown up in Connecticut, I admire CPA's renewed efforts to obtain this clinical responsibility, under the leadership of former CPA President and RxP committee chair Barbara Bunk.  Connecticut has an impressive history of providing visionary leadership for the profession, with Alan Kazdin, Bob Sternberg, and the late Neal Miller serving as APA Presidents.  Arthur Evans, APA's new CEO, and Dan Abrahamson, the driving force behind APA's extraordinary state level accomplishments, lived in the Nutmeg State for many years.  Ken Pope and Jeff Zimmerman are dedicated to insuring that our profession becomes aware of the clinical and policy developments occurring within other professions.  Academic and scientific colleagues across the nation have been blessed by the successes of Danbury's Alan Kraut who served as the first Executive Director of the Association for Psychological Science, and currently is Executive Director of the Psychological Clinical Science Accreditation System.

A major lesson learned from the initial RxP successes of Elaine LeVine (New Mexico) and James Quillin (Louisiana) is the importance of developing board-based grassroots support, especially from potential concerned beneficiaries.  We are convinced that psychology will only achieve parity within the nation's healthcare environment by focusing upon society's real needs, and not overly concerning ourselves with "professional turf" issues.  As your initial efforts under Michael Schwarzchild's leadership clearly demonstrated, RxP is fundamentally about increasing access to qualityhealthcare for those most in need.

            Give an Hour:  In our judgment, an exemplary example of "giving psychology away" has been the visionary efforts of Barbara Van Dahlen in establishing Give an Hour.  To date, she and her colleagues have provided more than 124,000 hours of free mental and behavioral health care, valued at over $24 million, through volunteer mental health professionals, for active duty military personnel, Veterans, and their families.  Recently, she has expanded her efforts to address the needs of those impacted by last year's extraordinary series of natural and man-made disasters, including Hurricane Harvey, as well as assisting other special populations who clearly are in need – including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.

            "Building on the tremendous success of the first Global Summit on Mental Health Culture Change held in Los Angeles, California in May, 2017, Give an Hour – in partnership with the UK Ministery of Defense, the Royal Foundation and Combat Stress – brings this exciting gathering to London in June, 2018.  The London Summit will continue the work accomplished in California by gathering together key thought leaders, government officials, stakeholders, policy makers and change agents to focus exclusively on addressing culture as a primary barrier to changing the way we think about, talk about and address emotional well-being and mental health so that all in need – including those who serve as well as civilians – are able to receive appropriate treatment and support.

            "Give an Hour, the backbone organization behind the Campaign to Change Direction, has created A Global Summit on Mental Health Culture Change to showcase successful efforts, forge new alliances and create the strategic vision necessary to eradicate the fear, shame and guilt that prevents those who are suffering from receiving the compassionate care they deserve.  Only through culture change will we achieve lasting change.  Last year, we invited APA President Tony Puente to participate in the summit.  I am excited to include several prominent psychologists among the presenters and participants this coming year" (Barbara Van Dahlen).

            Interprofessional Collaboration:  President Obama's landmark Patient Protection and Affordable Care Act (ACA) envisions a transformed healthcareenvironment in which patient-centered, integrated mental health care will be provided by interprofessional teams with an emphasis upon holistic and preventive care, in contrast to today's fee-for-procedure, acute care orientation.  Three years ago, the California Technology Assessment Forum (CTAF) report Integrating Behavioral Health into Primary Care noted: "Despite a long history in the US of treating physical health conditions separately from behavioral health, the two are inextricably linked.  Up to 70% of physician visits are for issues with a behavioral health component.  A similar percentage of adults with behavioral health conditions have one or more physical health issues.  Having a chronic condition is a risk factor for having a behavioral health condition and vice versa.  Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions."  CTAF further noted that anxiety and depression are the most common behavioral health disorders in primary care settings.

            Visionary Initiatives – One Step at a Time:  "From the mid-90s until the internship at Federal Correctional Institution at Petersburg, Virginia was closed in 2001, we had all our interns participate in psychiatry's rounds with the option to do a minor rotation in clinical psychopharmacology.  We created medication information sheets for the inmate-patients.  One of our interns, whose first language was Spanish, created a Spanish-language version which was very helpful.  The first psychiatrist I worked with at the prison was adamantly opposed to giving patients information about meds.  He thought that keeping them ignorant made them more compliant.  Working with him was how I began to support RxP" [Bob Ax].  Linda Campbell who initiated one of psychology's first RxP training programs with her University of Georgia pharmacy colleagues: "A colleague and I have developed an integrated free clinic in Athens.  We are growing a training program for pharmacy and psychology students working shoulder to shoulder in achieving incredible health outcomes for low SES rural populations.  I have worked closely with the College of Pharmacy since our initial efforts and it has paid off."

Last year APA convened a Task Force to review, and where appropriate, update the criteria for the curriculum for APA designated RxP training programs.  Their report is out for public comment and expected to be submitted to Council this year.  Those interested in providing didactic training at the graduate level will be pleased.  As Tony Puente and Fernanda De Oliveira have noted, many Early Career Psychologists interested in pursuing this clinical responsibility will no longer have to "start from scratch" and wonder if, during their already extensive training, they had obtained a sufficient foundation to pursue RxP.  Hopefully, increasing opportunities for interprofessional psychopharmacology training will also evolve.  [Tony Puente].  Aloha,

Pat DeLeon, former APA President – CPA – February, 2018

 

Sent from my iPhone

ALOHA - CPA column

“IT IS MY TIME TO GIVE BACK, SINCE SO MANY HAVE GIVEN TO ME”

In November 1984, at the Hawaii Psychological Association (HPA) annual convention, U.S. Senator Daniel K. Inouye urged the membership to seek prescriptive authority (RxP): “When you have obtained this statutory authority… you will be an autonomous profession and your clients will be well-served.”  In 1990, the APA Council of Representatives established its Task Force on Prescriptive Authority, chaired by Michael Smyer, and on which APA Past President Tony Puente served.  The task force concluded: “practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge.  The contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment.”

Having grown up in Connecticut, I admire CPA’s renewed efforts to obtain this clinical responsibility, under the leadership of former CPA President and RxP committee chair Barbara Bunk.  Connecticut has an impressive history of providing visionary leadership for the profession, with Alan Kazdin, Bob Sternberg, and the late Neal Miller serving as APA Presidents.  Arthur Evans, APA’s new CEO, and Dan Abrahamson, the driving force behind APA’s extraordinary state level accomplishments, lived in the Nutmeg State for many years.  Ken Pope and Jeff Zimmerman are dedicated to insuring that our profession becomes aware of the clinical and policy developments occurring within other professions.  Academic and scientific colleagues across the nation have been blessed by the successes of Danbury’s Alan Kraut who served as the first Executive Director of the Association for Psychological Science, and currently is Executive Director of the Psychological Clinical Science Accreditation System.

A major lesson learned from the initial RxP successes of Elaine LeVine (New Mexico) and James Quillin (Louisiana) is the importance of developing board-based grassroots support, especially from potential concerned beneficiaries.  We are convinced that psychology will only achieve parity within the nation’s healthcare environment by focusing upon society’s real needs, and not overly concerning ourselves with “professional turf” issues.  As your initial efforts under Michael Schwarzchild’s leadership clearly demonstrated, RxP is fundamentally about increasing access to quality healthcare for those most in need.

            Give an Hour:  In our judgment, an exemplary example of “giving psychology away” has been the visionary efforts of Barbara Van Dahlen in establishing Give an Hour.  To date, she and her colleagues have provided more than 124,000 hours of free mental and behavioral health care, valued at over $24 million, through volunteer mental health professionals, for active duty military personnel, Veterans, and their families.  Recently, she has expanded her efforts to address the needs of those impacted by last year’s extraordinary series of natural and man-made disasters, including Hurricane Harvey, as well as assisting other special populations who clearly are in need – including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.

            “Building on the tremendous success of the first Global Summit on Mental Health Culture Change held in Los Angeles, California in May, 2017, Give an Hour – in partnership with the UK Ministery of Defense, the Royal Foundation and Combat Stress – brings this exciting gathering to London in June, 2018.  The London Summit will continue the work accomplished in California by gathering together key thought leaders, government officials, stakeholders, policy makers and change agents to focus exclusively on addressing culture as a primary barrier to changing the way we think about, talk about and address emotional well-being and mental health so that all in need – including those who serve as well as civilians – are able to receive appropriate treatment and support.

            “Give an Hour, the backbone organization behind the Campaign to Change Direction, has created A Global Summit on Mental Health Culture Change to showcase successful efforts, forge new alliances and create the strategic vision necessary to eradicate the fear, shame and guilt that prevents those who are suffering from receiving the compassionate care they deserve.  Only through culture change will we achieve lasting change.  Last year, we invited APA President Tony Puente to participate in the summit.  I am excited to include several prominent psychologists among the presenters and participants this coming year” (Barbara Van Dahlen).

            Interprofessional Collaboration:  President Obama’s landmark Patient Protection and Affordable Care Act (ACA) envisions a transformed healthcare environment in which patient-centered, integrated mental health care will be provided by interprofessional teams with an emphasis upon holistic and preventive care, in contrast to today’s fee-for-procedure, acute care orientation.  Three years ago, the California Technology Assessment Forum (CTAF) report Integrating Behavioral Health into Primary Care noted: “Despite a long history in the US of treating physical health conditions separately from behavioral health, the two are inextricably linked.  Up to 70% of physician visits are for issues with a behavioral health component.  A similar percentage of adults with behavioral health conditions have one or more physical health issues.  Having a chronic condition is a risk factor for having a behavioral health condition and vice versa.  Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions.”  CTAF further noted that anxiety and depression are the most common behavioral health disorders in primary care settings.

            Visionary Initiatives – One Step at a Time:  “From the mid-90s until the internship at Federal Correctional Institution at Petersburg, Virginia was closed in 2001, we had all our interns participate in psychiatry’s rounds with the option to do a minor rotation in clinical psychopharmacology.  We created medication information sheets for the inmate-patients.  One of our interns, whose first language was Spanish, created a Spanish-language version which was very helpful.  The first psychiatrist I worked with at the prison was adamantly opposed to giving patients information about meds.  He thought that keeping them ignorant made them more compliant.  Working with him was how I began to support RxP” [Bob Ax].  Linda Campbell who initiated one of psychology’s first RxP training programs with her University of Georgia pharmacy colleagues: “A colleague and I have developed an integrated free clinic in Athens.  We are growing a training program for pharmacy and psychology students working shoulder to shoulder in achieving incredible health outcomes for low SES rural populations.  I have worked closely with the College of Pharmacy since our initial efforts and it has paid off.”

Last year APA convened a Task Force to review, and where appropriate, update the criteria for the curriculum for APA designated RxP training programs.  Their report is out for public comment and expected to be submitted to Council this year.  Those interested in providing didactic training at the graduate level will be pleased.  As Tony Puente and Fernanda De Oliveira have noted, many Early Career Psychologists interested in pursuing this clinical responsibility will no longer have to “start from scratch” and wonder if, during their already extensive training, they had obtained a sufficient foundation to pursue RxP.  Hopefully, increasing opportunities for interprofessional psychopharmacology training will also evolve.  [Tony Puente].  Aloha,

Pat DeLeon, former APA President – CPA – February, 2018

 

‘CAUSE I’D RATHER RIDE ON MY MOTORCYCLE

The Prescriptive Authority (RxP) agenda continues to mature quite nicely with Hawaii Psychological Association RxP Chair Kelly Harnick receiving enthusiastic support from Mental Health America of Hawaii which listed Prescriptive Authority for Advanced Trained Medical Psychologists (RxP) as its first Access To Care Advocacy Priority.  Connecticut Psychological Association President Anne Klee reports that their state Department of Public Health (DPH) formed a Committee, which has now met three times, to consider CPA's request to expand their scope-of-practice to include RxP.  DPH will ultimately make a recommendation to the Public Health Committee of the Connecticut General Assembly for the 2018 Legislative Session.  One of the major lessons learned from the initial successes of Elaine LeVine (New Mexico) and James Quillin (Louisiana) is the political importance of developing board-based grassroots support, especially from potential patient/client beneficiaries.  Fundamentally, RxP is about increased access to qualityhealthcare.

Beth Rom-Rymer, who was absolutely critical in Illinois, in passing her state's RxP legislation in 2014, recently hosted her fourth Chicago evening event for those committed to advancing the agenda.  "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 Prescriptive Authority for psychologists."  Also participating in Beth's event, and receiving special commendations, were the Director of Medical Education, Vice Dean for Education, and Professor of Neurology at the Stritch School of Medicine, Loyola University Medical Center; and the President and CEO of AMITA Health Alexian Brothers Behavioral Health Hospital, who are committing their time, energy, and expertise to create a series of rotation experiences for prescribing psychology trainees.  Because of their significant support of the Illinois Prescriptive Authority movement, a number of other community partners, including: the Illinois Psychological Association (IPA) and its lobbying team; Thresholds, the oldest and largest social service organization in Illinois; NAMI; the Illinois Department of Corrections; the Illinois Department of Mental Health; the Illinois Department of Children and Family Services; the Chicago School of Professional Psychology; Concordia University; Adler University; University of Illinois, Urbana-Champaign; Northwestern University; Midwestern University; Northeastern Illinois University; Rosalind Franklin University of Medicine and Science; Chicago Lakeshore Hospital; Erie Family Health Center; and, legal partners were all represented at the networking event.

As she neared the end of her prepared program, Beth 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.  There was a strong feeling of accomplishment in how IPA has progressed in the implementation of its Prescriptive Authority statute and great enthusiasm for the prominent roles that prescribing psychologists will take in repairing a faltering mental health system.

In many ways, the essence of the public policy process intimately involves politics.  Last fall the American Association of Nurse Practitioners (AANP) alerted their membership: "The American Medical Association (AMA) took steps at its recent meeting to call for the creation of a national strategy to oppose legislative efforts that grant independent practice to non-physician practitioners through model legislation and national and state level campaigns.  While these tactics are not new, the AMA's ongoing physician protectionist resolutions are hurting patients and negatively impacting the health of our nation.  As we all know, the evidence is clear: Nurse practitioners provide safe, high quality care; and states where NPs are prevented from independent license consistently rank among the poorest on health outcomes, access to primary care and geographic disparities in care.  AANP has issued a statement in response to the AMA's resolution.  We will continue to fight for our patients and their right to high quality care delivered by the provider of their choice."

The healthcare environment of the future will dramatically emphasize interprofessional team practice within closed networks (e.g., Patient-Centered Medical Homes and Accountable Care Organizations) as envisioned by the Patient Protection and Affordable Care Act (ACA) of President Obama.  Mental and behavioral healthcare will increasingly be provided within integrated primary care settings.  When psychology first embarked on its state-level RxP quest, visionary Linda Campbell developed an innovative training program with her colleagues at the University of Georgia College of Pharmacy.  A similar visionary approach was taken by Judi Steinman at the University of Hawaii at Hilo.

At the national level, pharmacy has established The Board of Pharmacy Specialists which currently certifies specialists in eight different areas (e.g., ambulatory care, pediatrics, psychiatric pharmacy).  The number of specialty certified practitioners has grown quite dramatically in recent years as the complexity of patient management increases.  It is possible to find specialists by geographical region through the BPS website.   Pharmacy has been steadily expanding its scope-of-practice on both the federal (especially within the VA, as Kathy McNamara has observed) and state level, commensurate with its doctoral level of educational training.  As a result, an increasing number of states allow pharmacists to modify and initiate medication protocols.  In 2003 there were approximately 4,000 board certified specialists in clinical pharmacy.  By 2016 these numbers had increased to almost 28,000.  We look forward to the time when those interested in the RxP agenda will develop collaborative continuing education and patient-centered case seminar initiatives with pharmacy and/or advanced practice psychiatric nursing (APRNs).  The time has come for psychology's clinicians and educators to expand their vision in order to embrace interprofessional training as proposed by former APA President Susan McDaniel.

The Advent of Telehealth:  The transformation of healthcare is being significantly influenced by the expanding impact of technology on the delivery of care.  Stephen DeMers will soon be retiring as CEO of the Association of State and Provincial Psychology Boards (ASPPB).  We will greatly miss his vision and passion for the profession.  Under his leadership, the APA Council of Representatives endorsed in principle ASPPB's Psychology Interjurisdictional Compact (PSYPACT), a joint initiative with APA and the APA Insurance Trust, during our Denver convention.  The proposed "E-Passport" would allow the provision of psychological services by qualified licensed psychologists via electronic means across jurisdictional boundaries, without additional licensure, in the jurisdiction in which the client was physically present when receiving those services.  At the end of last year, the House of Representatives passed legislation so that VA providers could practice telehealth in any state, regardless of whether the provider or patient was located on federal property.  "Just want to ride on my motorcycle."  Aloha,

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

 

Sent from my iPhone

ALOHA - D42 column

‘CAUSE I’D RATHER RIDE ON MY MOTORCYCLE

The Prescriptive Authority (RxP) agenda continues to mature quite nicely with Hawaii Psychological Association RxP Chair Kelly Harnick receiving enthusiastic support from Mental Health America of Hawaii which listed Prescriptive Authority for Advanced Trained Medical Psychologists (RxP) as its first Access To Care Advocacy Priority.  Connecticut Psychological Association President Anne Klee reports that their state Department of Public Health (DPH) formed a Committee, which has now met three times, to consider CPA’s request to expand their scope-of-practice to include RxP.  DPH will ultimately make a recommendation to the Public Health Committee of the Connecticut General Assembly for the 2018 Legislative Session.  One of the major lessons learned from the initial successes of Elaine LeVine (New Mexico) and James Quillin (Louisiana) is the political importance of developing board-based grassroots support, especially from potential patient/client beneficiaries.  Fundamentally, RxP is about increased access to quality healthcare.

Beth Rom-Rymer, who was absolutely critical in Illinois, in passing her state’s RxP legislation in 2014, recently hosted her fourth Chicago evening event for those committed to advancing the agenda.  “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 Prescriptive Authority for psychologists.”  Also participating in Beth’s event, and receiving special commendations, were the Director of Medical Education, Vice Dean for Education, and Professor of Neurology at the Stritch School of Medicine, Loyola University Medical Center; and the President and CEO of AMITA Health Alexian Brothers Behavioral Health Hospital, who are committing their time, energy, and expertise to create a series of rotation experiences for prescribing psychology trainees.  Because of their significant support of the Illinois Prescriptive Authority movement, a number of other community partners, including: the Illinois Psychological Association (IPA) and its lobbying team; Thresholds, the oldest and largest social service organization in Illinois; NAMI; the Illinois Department of Corrections; the Illinois Department of Mental Health; the Illinois Department of Children and Family Services; the Chicago School of Professional Psychology; Concordia University; Adler University; University of Illinois, Urbana-Champaign; Northwestern University; Midwestern University; Northeastern Illinois University; Rosalind Franklin University of Medicine and Science; Chicago Lakeshore Hospital; Erie Family Health Center; and, legal partners were all represented at the networking event.

As she neared the end of her prepared program, Beth 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.  There was a strong feeling of accomplishment in how IPA has progressed in the implementation of its Prescriptive Authority statute and great enthusiasm for the prominent roles that prescribing psychologists will take in repairing a faltering mental health system.

In many ways, the essence of the public policy process intimately involves politics.  Last fall the American Association of Nurse Practitioners (AANP) alerted their membership: “The American Medical Association (AMA) took steps at its recent meeting to call for the creation of a national strategy to oppose legislative efforts that grant independent practice to non-physician practitioners through model legislation and national and state level campaigns.  While these tactics are not new, the AMA’s ongoing physician protectionist resolutions are hurting patients and negatively impacting the health of our nation.  As we all know, the evidence is clear: Nurse practitioners provide safe, high quality care; and states where NPs are prevented from independent license consistently rank among the poorest on health outcomes, access to primary care and geographic disparities in care.  AANP has issued a statement in response to the AMA’s resolution.  We will continue to fight for our patients and their right to high quality care delivered by the provider of their choice.”

The healthcare environment of the future will dramatically emphasize interprofessional team practice within closed networks (e.g., Patient-Centered Medical Homes and Accountable Care Organizations) as envisioned by the Patient Protection and Affordable Care Act (ACA) of President Obama.  Mental and behavioral healthcare will increasingly be provided within integrated primary care settings.  When psychology first embarked on its state-level RxP quest, visionary Linda Campbell developed an innovative training program with her colleagues at the University of Georgia College of Pharmacy.  A similar visionary approach was taken by Judi Steinman at the University of Hawaii at Hilo.

At the national level, pharmacy has established The Board of Pharmacy Specialists which currently certifies specialists in eight different areas (e.g., ambulatory care, pediatrics, psychiatric pharmacy).  The number of specialty certified practitioners has grown quite dramatically in recent years as the complexity of patient management increases.  It is possible to find specialists by geographical region through the BPS website.   Pharmacy has been steadily expanding its scope-of-practice on both the federal (especially within the VA, as Kathy McNamara has observed) and state level, commensurate with its doctoral level of educational training.  As a result, an increasing number of states allow pharmacists to modify and initiate medication protocols.  In 2003 there were approximately 4,000 board certified specialists in clinical pharmacy.  By 2016 these numbers had increased to almost 28,000.  We look forward to the time when those interested in the RxP agenda will develop collaborative continuing education and patient-centered case seminar initiatives with pharmacy and/or advanced practice psychiatric nursing (APRNs).  The time has come for psychology’s clinicians and educators to expand their vision in order to embrace interprofessional training as proposed by former APA President Susan McDaniel.

The Advent of Telehealth:  The transformation of healthcare is being significantly influenced by the expanding impact of technology on the delivery of care.  Stephen DeMers will soon be retiring as CEO of the Association of State and Provincial Psychology Boards (ASPPB).  We will greatly miss his vision and passion for the profession.  Under his leadership, the APA Council of Representatives endorsed in principle ASPPB’s Psychology Interjurisdictional Compact (PSYPACT), a joint initiative with APA and the APA Insurance Trust, during our Denver convention.  The proposed “E-Passport” would allow the provision of psychological services by qualified licensed psychologists via electronic means across jurisdictional boundaries, without additional licensure, in the jurisdiction in which the client was physically present when receiving those services.  At the end of last year, the House of Representatives passed legislation so that VA providers could practice telehealth in any state, regardless of whether the provider or patient was located on federal property.  “Just want to ride on my motorcycle.”  Aloha,

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