“THE WILL OF THE PEOPLE IS THE BEST LAW”
The Buckeye State – Continuing to Set the Agenda: Ted Strickland was the first psychologist to be elected to the U.S. House of Representatives and when elected Governor of Ohio, he was also the first psychologist to serve in that position. Former APA President Ron Levant recently shared with us a report on the ongoing efforts in his adopted State to obtain prescriptive authority (RxP). In his various roles within the APA governance, Ron has always been supportive of this particular agenda, seeing it as a natural expansion of psychology’s role within the overall healthcare arena. The late-Ron Fox -- former APA President, founding Dean of the Wright State Professional School, and the Grandfather of the RxP movement -- used to muse about how his Ohio academic nursing colleagues appreciated that there were many ways to accomplish one’s ultimate objective. They had obtained a major foundation grant to expand their clinical outreach capacities, given the significant healthcare needs throughout the rural areas of the state. Then, with the active endorsement of the foundation staff, Ron reported that they informed the Governor that unless they could have prescriptive authority, their grant funding would not be released. The Governor concurred and the first step was RxP authority for the nursing students supervised by the university faculty. As these students graduated, their clinical authority continued to expand, given the high quality of needed care being provided.
One must appreciate that substantive change takes time; often times far longer than one might initially expect. It was actually back in 1995 when the Ohio Nurses Association (ONA) formally sought legislation providing their Advanced Practice Nurses (APRNs) with prescriptive authority, under the leadership of Margaret Wheatley, who was their first African-American President. From a policy perspective, the Ohio nurses’ creative geographical approach nicely paralleled OPA’s efforts to begin psychology’s RxP within the State’s prison system, similar to an earlier effort attempted by the late-Chuck Faltz in the State of California. As clinicians, APRNs now possess this clinical responsibility, under various conditions, throughout the nation and within the federal healthcare delivery systems, especially within the Department of Veterans Administration (VA).
Brad Potts is serving as the current Ohio Psychological Association (OPA) Advocacy Chair and has been working on the RxP initiative for the past decade, along with his colleagues Jerry Strauss who has been at it for over two decades, and Angela Miller, who is chair of their RxP Committee. Both Brad and Angela are graduates of the Alliant psychopharmacology program. This legislative session three hearings have been held on their current bill, H.B. 326, with testimonies received from Ruth Roe-Navarrete, who is a prescribing psychologist at Wright Patterson Air Base, Marlin Hoover, a prescribing psychologist from New Mexico (and who was instrumental to the Illinois Psychological Association’s recent legislative success), and Jerry.
Brad: “In addition to their broad clinical experience both were able to testify about helping train medical students how to prescribe psychotropic medications. Supportive testimony was also provided from the University of Findlay Pharmacy program about their Masters in Psychopharmacology that they have approved and are prepared to launch once the Ohio bill passes. For the past six months we have worked to address a series of issues raised by the opposition. That work is now done and we have a solid piece of legislation. I think it is the strongest bill we have had. Our interactions with lawmakers have been largely positive and our current stance is that we are cautiously optimistic, especially with Michael Ranney’s steady calming guidance.”
Jerry: “The APRNs in Ohio started their venture for independence and prescriptive authority in 1988. The bill for RxP finally passed for them on 1/12/2000. The very last state to pass the law for APRNs. When I testified on our bill, I cited the DoD Demonstration Project and other empirical evidence demonstrating safe, effective, and judicious prescribing practices by prescribing psychologists. Channel 6 in Columbus Ohio interviewed me after the testimony and aired the interview in Ohio, West Virginia, and parts of Indiana and Pennsylvania. I have been participating in each interested party meeting between OPA, the Ohio Psychiatric Physicians Association/Ohio State Medical Board, and our bill’s sponsors. Each of these meetings has been positive in our favor. I guess those responsibilities should fall to the grandfather of RxP in Ohio and I will continue to play a role until our bill is written into law in our state.”
Kathy McNamara, another long time Ohio colleague who was formerly at Wright State University and now lives on the Hawaiian island of Maui, recently retired from the VA after nearly four decades of service. Her thoughts on the importance of the profession obtaining this clinical responsibility in order to serve our nation’s Veterans: “The development with VA pharmacists prescribing occurred even before I retired. I recall my disbelief that our VA pharmacists – with no formal training in psychological issues or mental health treatment – could prescribe psychotropics and VA psychologists still could not. The recruitment ads for VA pharmacists include reference to both their contributions to interdisciplinary practice (in a collaborative way) and to the fact that ‘Clinical Pharmacy Specialists’ have ‘authority to prescribe and monitor medication therapies.’ My own psychopharmacology training program included pharmacists – and I learned a significant amount from those lectures, and have great respect for pharmacists – but I am disappointed in how reticent our own VA psychologists have been to think outside the box and move this forward. In the VA, structure always supersedes function: creating a title for some of the VA psychologists who become ‘Clinical Psychology Specialists’ with a scope of practice to prescribe (or even as a first step, advise in primary care staffing of patients about how to integrate therapy and medication) can go a long way. I am just so appreciative of Heather Kelly’s persistence in the legislative arena.” We would rhetorically ask: “Will our next generation of VA psychologists listen to the vision of their senior VA, now retired, colleagues Kathy and Jerry? Or, will they be content with the status quo, allowing Jerry to continue flying a helicopter around the state?”
The Importance of Developing an Interprofessional Orientation: 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 pharmacy 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 Board’s website. Pharmacy has been steadily expanding its scope-of-practice on both the federal 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 2014 these numbers had increased to almost 22,000. As Brad and Kathy have indicated, and as experienced by Linda Campbell during the original Georgia Psychological Association efforts in the very beginning of the RxP movement – not to mention her recent interprofessional community care efforts – Colleges of Pharmacy have been extraordinarily supportive of psychology’s psychopharmacology quest.
Team-based, interprofessional care, capitalizing upon the potential contributions of the advances occurring within the communications and technology fields (i.e., telehealth), is the future for our nation’s healthcare environment. We are entering a transformational era. In November, 2013 the Health Resources and Services Administration (HRSA) released its report Projecting the Supply and Demand for Primary Care Practitioners Through 2020. “Demand for primary care services is projected to increase through 2020, due largely to aging and population growth and, to a much lesser extent, the expanded insurance coverage implemented under the Affordable Care Act, which includes a number of investments that strengthen the primary care workforce…. The supply of NPs and PAs, however, is projected to grow rapidly and could mitigate the projected shortage of physicians if NPs and PAs continue to be effectively integrated into the primary care delivery system. In order for this integration to occur, patient and health system acceptance is necessary and the dissemination of more effective models of workforce deployment must continue. New models that allow for an increased role of NPs and PAs in the provision of primary care services, such as patient-centered medical homes that emphasize team-based care, have the potential to help address the projected shortage of primary care physicians…. Aging and population growth are projected to account for 81 percent of the change in demand between 2010 and 2020.” The supply of primary care NPs is projected to increase by 30%, from 55,400 in 2010 to 72,100 in 2020. Will prescribing psychologists actively engage in the public policy (i.e., political) process in order to became participants in shaping their own professional destiny?
Increasing Signs of Bipartisanship on Behalf of Our Nation’s Veterans: On May 24, 2018 the U. S. House of Representatives passed the National Defense Authorization Act for FY’ 2019 (H.R. 5515) by a vote of 351-66. In this legislation was a provision proffered by Heather O’Beirne Kelly, Director of the APA Office of Military and Veterans Health Policy, to Hawaii’s Congresswoman Tulsi Gabbard, herself a Veteran. “GAO Audit of TRICARE…. There is evidence that mental health providers from the East and West regions received new contracts that include a proposed 30% discount off… CHAMPUS rates. With the limited options and resources that TRICARE beneficiaries currently have, these discounts will further jeopardize the mental health of military members, veterans, and their families who rely on TRICARE for their basic needs. Therefore, the committee directs the Comptroller General of the U.S. Government Accountability Office (GAO) to conduct a study of the Defense Health Agency’s (DHA) oversight of the transition of TRICARE managed care support contractors for its TRICARE regions” (Ulysses S. Grant). Aloha,
Pat DeLeon, former APA President – Division 55 – June, 2018
