‘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
