ALOHA - Div. One column

AN EXCITING CHALLENGE -- MEANINGFUL RETIREMENT

            Based upon our conversations with colleagues a number of years ago, VA psychology historian Rod Baker and I found that increasing numbers of psychologists were facing or entering retirement and many told us that they were not well prepared for that life shift.  In 2014, we prepared a symposium for the APA convention to provide help for those approaching their retirement years.  We believed that hearing the stories and lessons learned of psychologists who had already retired would be useful for others in anticipating and dealing with issues faced in retirement.  Initially, our audience was small – 25 for the first symposium -- although their active participation was encouraging.  In 2016, several attendees mentioned that they had stayed over for the Sunday presentations just to attend “Meaningful Retirement.”  We had 90 attend that Sunday morning symposium.  Interest continued to grow and in San Francisco at the APA 126^th Annual Convention, there were over 120 in attendance.

Reflecting, I recall that when I served as APA President in 2000, Ruby Takanishi engaged the Council of Representatives in a discussion on the nation’s (and psychology’s) changing demographics, including aging, and the potential impact of technology on the field.  It was evident that few colleagues could appreciate the magnitude of change that was forthcoming.  In a similar light, over the years the Sunday morning presentations on psychology’s potential contributions to the field of gerontology, which I always found fascinating, were often sparsely attended.

            During the five years we have presented at APA our symposium speakers have proffered several consistent messages.  First, that many psychologists begin thinking of retirement as continuing some psychological activity with a “not-doing-as-much” intention.  And that whatever psychologists were doing at the start of their retirement was not always the same as what they were doing in the middle to later retirement years.  For some, the retirement years became a time to make some shifts in what they were doing for most of their careers.  Whatever was chosen in retirement, however, it was important for most to retain a sense of achievement or satisfaction that had been given them during their career.  Becoming engaged in what one now felt was a meaningful activity was critical.  As Rod would point out, “If you do not like what you are doing, there is only one person to talk to.”

Some of our speakers, such as APA’s Merry Bullock, have actively expanded their trademark, for her international, contributions; others, such as Tom Grisso, after 45 years of academic service, have finally taken the time to publish thoughtful reflections on developing the truly significant interface between psychology and the law, not to mention becoming involved within the APA governance.  In contrast, Mike Sullivan has been actively engaged in volunteering to serve his local community’s senior citizen population – meals on wheels; while Rod has become an accomplished author of fiction novels.  Our most recent audience requests have included expanding our presentations to explore the unique challenges of increasing physical disabilities, as well as the journeys of colleagues who grew up in socially disadvantaged environments, often being the first in their families to graduate from high school, let alone obtain their doctorates.  A difficult challenge in the traditional 50 minute convention format.  We have no doubt that we have been surfing a wave that will become of increasing personal interest to a growing number of colleagues.

            From a policy perspective, there has long been concern regarding mental health issues facing our nation’s elderly.  President Carter’s Commission on Mental Health Report (1978): “At the other end of the age spectrum, the 23 million Americans over the age of sixty-five – one third of whom are below the official poverty line – constitute another large segment of the population underserved by our current mental health care system.  The prevalence of mental illness and emotional distress is higher among those over age sixty-five than in the general population.  Up to 25 percent of older persons have been estimated to have significant mental health problems….”  The First Surgeon General’s Report on Mental Health (1999): “Mental health and mental illness are dynamic, ever-changing phenomena….  Stressful life events, such as declining health and/or the loss of mates, family members, or friends often increase with age….  Disability due to mental illness in individuals over 65 years old will become a major public health problem in the near future because of demographic changes.”  We rhetorically ask: Should one assume that because many years ago we chose to study and/or embrace the profession of psychology, we should expect to be exempt from these national trends?  Alternatively, has psychology collectively become engaged in addressing the projected behavioral and mental health needs of our nation’s elderly?  Or, as Mike raises, addressing the ultimate meaning-of-life issues that retirement raises?  Aloha,

Pat DeLeon, former APA President – Division One – August, 2018

SAN FRANCISCO – OUR 126th ANNUAL CONVENTION

APA conventions are always extremely exciting. It is wonderful to see old friends once again. Naturally, critical cutting-edge, transformational topics always fill the program:

Licensure Mobility: Immediately after the convention, the Association of State and Provincial Psychology Boards (ASPPB) held its second Psychology Interjurisdictional Compact (PSYPACT) Educational Summit in Washington, DC. Representatives from 17 state psychological associations and licensing boards, as well as their state legislators, attended this invited summit. The purpose of the summit was to provide information on PSYPACT and how it will function. Briefly, it allows individual psychologists to provide ethical and legal electronic interjurisdictional psychological services to clients. It will vet psychologists to make sure they have the requisite education, training, and supervised experience, as well as no disciplinary or criminal history, to ensure the public is protected. More specifically, psychologists who are licensed in a compact state (which requires legislative action) will be authorized to provide electronic psychological services into another compact state without having to be licensed in that jurisdiction. It will also allow psychologists to temporarily provide face-to-face service in another jurisdiction without being licensed.

PSYPACT will become operational when seven jurisdictions pass legislation adopting the compact. To date, Arizona, Utah, Nevada, Colorado, Nebraska, and Missouri have passed enabling legislation. Most recently, Illinois enacted their statute, making it the seventh state. However, unlike the first six states where their laws will become effective when seven states have similarly acted, Illinois will not become effective until January 1, 2020. Thus, while seven jurisdictions have adopted PSYPACT, in reality, until January 2020, there are only six states. ASPPB is optimistic since eight to 12 additional states are expected to introduce legislation in their next legislative cycle. [For more information, contact Alex Siegel at asiegel@asppb.org.]

RxP: That weekend, I had the pleasure of attending Beth Rom-Rymer's Fifth Biannual Prescriptive Authority Networking dinner in the Windy City of Chicago. APA Chief Executive Officer Art Evans, Beth's fellow APA Board Member Stewart Cooper, along with Angela Miller of Ohio and David Greenfield of Connecticut -- representing states that are inching closer and closer to enacting prescriptive authority legislation (RxP) -- were present. The enthusiasm was electrifying, generated by numerous Illinois (IPA) members, engaged community supporters, and especially their RxP students. In all, there were approximately 115 in attendance. Substantive change always takes time; often far more than one might expect. IPA, under then-President Beth, saw its landmark RxP legislation signed into law on June 25, 2014. Today there are two Illinois colleagues awaiting formal State approval of their prescribing psychologist's license applications. What is truly impressive about IPA's success is its visionary commitment to ensuring that graduate students could receive the clinical training at the Pre-Doctoral level. In essence, IPA became the catalyst for the recent endorsement of this educational evolution by the APA Committee on the Designation of Training Programs in Clinical Psychopharmacology. From a policy perspective, the sooner this critical training becomes readily available, throughout the country, the more significant the support will be for the training of prescribing psychologists within psychology's next generation of clinicians, researchers, and educators. As the national elections approach, at least eight Democratic physicians are running for Congress as first-time candidates. Are any of your members running for local, state, or federal office? Aloha,

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



Sent from my iPhone

ALOHA - Div 31 column

SAN FRANCISCO – OUR 126^th ANNUAL CONVENTION

APA conventions are always extremely exciting.  It is wonderful to see old friends once again.  Naturally, critical cutting-edge, transformational topics always fill the program:

            Licensure Mobility:  Immediately after the convention, the Association of State and Provincial Psychology Boards (ASPPB) held its second Psychology Interjurisdictional Compact (PSYPACT) Educational Summit in Washington, DC.  Representatives from 17 state psychological associations and licensing boards, as well as their state legislators, attended this invited summit.  The purpose of the summit was to provide information on PSYPACT and how it will function.  Briefly, it allows individual psychologists to provide ethical and legal electronic interjurisdictional psychological services to clients.  It will vet psychologists to make sure they have the requisite education, training, and supervised experience, as well as no disciplinary or criminal history, to ensure the public is protected.  More specifically, psychologists who are licensed in a compact state (which requires legislative action) will be authorized to provide electronic psychological services into another compact state without having to be licensed in that jurisdiction.  It will also allow psychologists to temporarily provide face-to-face service in another jurisdiction without being licensed.

            PSYPACT will become operational when seven jurisdictions pass legislation adopting the compact.  To date, Arizona, Utah, Nevada, Colorado, Nebraska, and Missouri have passed enabling legislation.  Most recently, Illinois enacted their statute, making it the seventh state.  However, unlike the first six states where their laws will become effective when seven states have similarly acted, Illinois will not become effective until January 1, 2020.  Thus, while seven jurisdictions have adopted PSYPACT, in reality, until January 2020, there are only six states.  ASPPB is optimistic since eight to 12 additional states are expected to introduce legislation in their next legislative cycle.  [For more information, contact Alex Siegel at asiegel@asppb.org.]

            RxP:  That weekend, I had the pleasure of attending Beth Rom-Rymer’s Fifth Biannual Prescriptive Authority Networking dinner in the Windy City of Chicago.  APA Chief Executive Officer Art Evans, Beth’s fellow APA Board Member Stewart Cooper, along with Angela Miller of Ohio and David Greenfield of Connecticut -- representing states that are inching closer and closer to enacting prescriptive authority legislation (RxP) -- were present.   The enthusiasm was electrifying, generated by numerous Illinois (IPA) members, engaged community supporters, and especially their RxP students.  In all, there were approximately 115 in attendance.  Substantive change always takes time; often far more than one might expect.  IPA, under then-President Beth, saw its landmark RxP legislation signed into law on June 25, 2014.  Today there are two Illinois colleagues awaiting formal State approval of their prescribing psychologist’s license applications.  What is truly impressive about IPA’s success is its visionary commitment to ensuring that graduate students could receive the clinical training at the Pre-Doctoral level.  In essence, IPA became the catalyst for the recent endorsement of this educational evolution by the APA Committee on the Designation of Training Programs in Clinical Psychopharmacology.  From a policy perspective, the sooner this critical training becomes readily available, throughout the country, the more significant the support will be for the training of prescribing psychologists within psychology’s next generation of clinicians, researchers, and educators.  As the national elections approach, at least eight Democratic physicians are running for Congress as first-time candidates.  Are any of your members running for local, state, or federal office?  Aloha,

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

THE CITY BY THE BAY

APA's 126th Annual Convention: The 12,300+ who attended our annual convention this August in San Francisco were pleasantly reminded during President Jessica Henderson Daniel's remarkable Opening Session why many of us chose psychology – to serve society and help make the world a better place for all. Hawaii colleagues were ever present. Former Hawaii Psychological Association (HPA) President Jill Oliveira Gray received the Division 31 Outstanding Psychologist award; Sunday morning, she described the importance of Expanding Behavioral Health Services in Rural Settings Through Innovations in Training, especially involving Native Hawaiians. Another former HPA President, Kate Brown, moderated the heart-warming discussion by Jessica's Citizen Psychologists who have throughout their impressive careers "given psychology away" to their local communities.

Judi Steinman, President-Elect of Division 55, received the Division's Psychopharmacology Educator of the Year award. During the convention she participated in several panels addressing the transformational movement towards training clinical psychopharmacology (RxP) at the pre-doctoral level. "HPA maintains its commitment to pursuing prescriptive authority for specially trained psychologists in our state. Our ongoing challenges with underserved rural and overpopulated homeless communities across our islands highlight the continued, urgent need for better mental health care access. Increasing numbers of local students have expressed interest in becoming prescribing psychologists for their underserved communities and will be fully engaged in the effort to move legislation forward." One of the major themes that was expressed throughout the RxP presentations was that the key to successful advocacy was to develop grass roots community support and consistently be client, rather than guild-focused. This approach has always been HPA's strength.

Military Medicine: One of the most fascinating aspects of working at the Uniformed Services University (USU) is interacting on a daily basis with dedicated, experienced faculty and the truly inspiring next generation of our nation's federal health care providers. Medical and Clinical Psychology graduate student Sade Soares is beginning her clinical internship this fall at the Tripler Army Medical Center. She is a 2010 graduate of West Point. Her husband and two very young children are Native Hawaiian. Not surprisingly, her dissertation focuses upon the relationship between Native Hawaiian cultural identify and health/wellness.

The military (including its family members) possesses its own unique culture, strengths, and challenges. Maintaining Readiness is a critical responsibility and the visionary faculty at the USU Daniel K. Inouye Graduate School of Nursing have developed an impressive two week series operational curricula – Military Mountain Medicine, Cold Weather Medicine, and Dive Medicine. Learning the most up-to-date clinical skills is absolutely necessary; but it is not sufficient. Future providers must also be physically, emotionally, and operationally ready. Matt Welder, Ian Wedmore, and Matt D'Angelo have taken the lead in embedding psychology and mental health nursing students into their training modules in order to provide them with "real life" experiences in learning how to appropriately treat military service members as part of an interprofessional team, in what will often be extraordinarily austere and hostile environments. Hannah Martinez and Julia Garza participated in their most recent module. Their enthusiastic observations:

"It was a lot like drinking water from a fire hose, but we learned so much. Not only did we gain medical knowledge that makes us a more valuable member of an operational team, but we made interprofessional connections that will last for the rest of our careers. Having to ask what the definition of medical terms are a couple dozen times a day really lends itself to getting to know the people around you! It was also amazing to be able to show other medical providers the utility of psychology and emotional readiness in an operational environment. We were able to answer questions, give unique perspectives, and we even presented on psychological topics to the entire class (for example, cognitive deficits related to insomnia and high altitude psychosis). Our leader [Matt Welder] believes in what we do – he is not scared to correct people who think emotional readiness isn't important, which is so reinforcing to a couple of 'shrinks' among some of the top medical minds in the military!" (Hannah).

"There was such a steep learning curve while we were there but we learned so much in the short amount of time we were there. We were both ecstatic that we passed the final exam on the last day because we lacked the initial medical knowledge several of the other individuals in the class had. I think it also gave me an even deeper respect for the medical providers and individuals who provide care within austere conditions, such as on deployment or within a wilderness environment. It was pretty amazing being able to interact with the wide range of providers and individuals that work within Special Operations. It was also really nice to hear our leader talk about how much he valued emotional readiness to prepare service members for operational settings. Being at the Mountain Medicine course also gave us several opportunities to discuss our role as a behavioral health provider with some of the service members that work with the Special Operation teams. There were also a couple of former USU graduates from the medical school that happened to be at the course and one of them repeatedly talked about the utility our field can offer to the teams.

"In both the public and private healthcare environments, there has been increasing emphasis on interprofessional care within the larger field of psychology and this trend has been especially seen within the military through the number of increased embedded and operational billets. This course provided exposure to interprofessional care by having us working closely with medics, physician assistants, physicians, and advanced practice nurses (APRNs). I appreciated that the other students were very willing to hear about my clinical experiences through a psychology perspective, and they were also willing to share their various medical experiences. Interacting with individuals that have worked within Special Operational settings gave us both an intriguing perspective on how psychologists could potentially be utilized to help ensure deployment readiness, whether that be helping service members sleep more efficiently or helping other providers be more aware of potential behavioral health concerns. More broadly, the course gave me a greater appreciation and understanding of the amount of detail involved in helping to provide care and rescue services to members in austere geographical locations. It was especially challenging because it forced me to be able to handle potential crises while in an unfamiliar environment. But, developing this skill is vital. It is important for behavioral health providers to have a real understanding of the conditions their patients may have been exposed to while working within an operational setting. We both hope to be able to attend Dive Medicine next year" (Julia). Most appropriately, during our San Francisco convention USU's Jeff Goodie presented the APF Rosalee G. Weiss Lecture for Outstanding Leaders in Psychology – "Integrating Behavioral Health in Primary Care and in Communities Following Tragedies: Lessons Learned." Jeff is a Commissioned Officer in the USPHS.

We were personally particularly pleased to learn that just after our convention, during the U.S. Senate passage of the Labor-HHS-Education FY'19 Appropriations bill (the DOD/LHHS Minibus), that Hawaii's Senator Brian Schatz was successful in having an amendment adopted which directs SAMHSA to assess the ongoing mental health impact on the children and families affected by the recent volcano eruptions (VOG). His amendment calls for a needs assessment and for developing mental health crisis recovery plans targeted to these unique circumstances. Aloha,

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


Sent from my iPhone

ALOHA - HPA

THE CITY BY THE BAY

APA’s 126^th Annual Convention:  The 12,300+ who attended our annual convention this August in San Francisco were pleasantly reminded during President Jessica Henderson Daniel’s remarkable Opening Session why many of us chose psychology – to serve society and help make the world a better place for all.  Hawaii colleagues were ever present.  Former Hawaii Psychological Association (HPA) President Jill Oliveira Gray received the Division 31 Outstanding Psychologist award; Sunday morning, she described the importance of Expanding Behavioral Health Services in Rural Settings Through Innovations in Training, especially involving Native Hawaiians.  Another former HPA President, Kate Brown, moderated the heart-warming discussion by Jessica’s Citizen Psychologists who have throughout their impressive careers “given psychology away” to their local communities.

Judi Steinman, President-Elect of Division 55, received the Division’s Psychopharmacology Educator of the Year award.  During the convention she participated in several panels addressing the transformational movement towards training clinical psychopharmacology (RxP) at the pre-doctoral level.  “HPA maintains its commitment to pursuing prescriptive authority for specially trained psychologists in our state.  Our ongoing challenges with underserved rural and overpopulated homeless communities across our islands highlight the continued, urgent need for better mental health care access.  Increasing numbers of local students have expressed interest in becoming prescribing psychologists for their underserved communities and will be fully engaged in the effort to move legislation forward.”  One of the major themes that was expressed throughout the RxP presentations was that the key to successful advocacy was to develop grass roots community support and consistently be client, rather than guild-focused.  This approach has always been HPA’s strength.

            Military Medicine:  One of the most fascinating aspects of working at the Uniformed Services University (USU) is interacting on a daily basis with dedicated, experienced faculty and the truly inspiring next generation of our nation’s federal health care providers.  Medical and Clinical Psychology graduate student Sade Soares is beginning her clinical internship this fall at the Tripler Army Medical Center.  She is a 2010 graduate of West Point.  Her husband and two very young children are Native Hawaiian.  Not surprisingly, her dissertation focuses upon the relationship between Native Hawaiian cultural identify and health/wellness.

The military (including its family members) possesses its own unique culture, strengths, and challenges.  Maintaining Readiness is a critical responsibility and the visionary faculty at the USU Daniel K. Inouye Graduate School of Nursing have developed an impressive two week series operational curricula – Military Mountain Medicine, Cold Weather Medicine, and Dive Medicine.  Learning the most up-to-date clinical skills is absolutely necessary; but it is not sufficient.  Future providers must also be physically, emotionally, and operationally ready.  Matt Welder, Ian Wedmore, and Matt D’Angelo have taken the lead in embedding psychology and mental health nursing students into their training modules in order to provide them with “real life” experiences in learning how to appropriately treat military service members as part of an interprofessional team, in what will often be extraordinarily austere and hostile environments.  Hannah Martinez and Julia Garza participated in their most recent module.  Their enthusiastic observations:

“It was a lot like drinking water from a fire hose, but we learned so much.  Not only did we gain medical knowledge that makes us a more valuable member of an operational team, but we made interprofessional connections that will last for the rest of our careers.  Having to ask what the definition of medical terms are a couple dozen times a day really lends itself to getting to know the people around you!  It was also amazing to be able to show other medical providers the utility of psychology and emotional readiness in an operational environment.  We were able to answer questions, give unique perspectives, and we even presented on psychological topics to the entire class (for example, cognitive deficits related to insomnia and high altitude psychosis).  Our leader [Matt Welder] believes in what we do – he is not scared to correct people who think emotional readiness isn’t important, which is so reinforcing to a couple of ‘shrinks’ among some of the top medical minds in the military!” (Hannah).

“There was such a steep learning curve while we were there but we learned so much in the short amount of time we were there.  We were both ecstatic that we passed the final exam on the last day because we lacked the initial medical knowledge several of the other individuals in the class had.  I think it also gave me an even deeper respect for the medical providers and individuals who provide care within austere conditions, such as on deployment or within a wilderness environment.  It was pretty amazing being able to interact with the wide range of providers and individuals that work within Special Operations.  It was also really nice to hear our leader talk about how much he valued emotional readiness to prepare service members for operational settings.  Being at the Mountain Medicine course also gave us several opportunities to discuss our role as a behavioral health provider with some of the service members that work with the Special Operation teams.  There were also a couple of former USU graduates from the medical school that happened to be at the course and one of them repeatedly talked about the utility our field can offer to the teams.

“In both the public and private healthcare environments, there has been increasing emphasis on interprofessional care within the larger field of psychology and this trend has been especially seen within the military through the number of increased embedded and operational billets.  This course provided exposure to interprofessional care by having us working closely with medics, physician assistants, physicians, and advanced practice nurses (APRNs).  I appreciated that the other students were very willing to hear about my clinical experiences through a psychology perspective, and they were also willing to share their various medical experiences.  Interacting with individuals that have worked within Special Operational settings gave us both an intriguing perspective on how psychologists could potentially be utilized to help ensure deployment readiness, whether that be helping service members sleep more efficiently or helping other providers be more aware of potential behavioral health concerns.  More broadly, the course gave me a greater appreciation and understanding of the amount of detail involved in helping to provide care and rescue services to members in austere geographical locations.  It was especially challenging because it forced me to be able to handle potential crises while in an unfamiliar environment.  But, developing this skill is vital.  It is important for behavioral health providers to have a real understanding of the conditions their patients may have been exposed to while working within an operational setting.  We both hope to be able to attend Dive Medicine next year” (Julia).  Most appropriately, during our San Francisco convention USU’s Jeff Goodie presented the APF Rosalee G. Weiss Lecture for Outstanding Leaders in Psychology – “Integrating Behavioral Health in Primary Care and in Communities Following Tragedies: Lessons Learned.”  Jeff is a Commissioned Officer in the USPHS.

We were personally particularly pleased to learn that just after our convention, during the U.S. Senate passage of the Labor-HHS-Education FY’19 Appropriations bill (the DOD/LHHS Minibus), that Hawaii’s Senator Brian Schatz was successful in having an amendment adopted which directs SAMHSA to assess the ongoing mental health impact on the children and families affected by the recent volcano eruptions (VOG).  His amendment calls for a needs assessment and for developing mental health crisis recovery plans targeted to these unique circumstances.  Aloha,

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

I LEFT MY HEART IN SAN FRANCISCO

The 12,300+ colleagues who attended the 126th annual APA convention in San Francisco were especially fortunate to be gently reminded, especially during the remarkable Opening Session, why we had chosen psychology many years ago. The Keynote address by Attorney Bryan Stevenson provided an emotionally moving glimpse into the lives of those caught up within the criminal justice system – especially children – who have historically been "powerless." Advancing social justice clearly remains a high priority for many of those in attendance. Throughout the convention, the personal stories of President Jessica Henderson Daniel's Citizen Psychologists provided an awesome appreciation for how individuals can make a real difference in the lives of our nation's citizens at the grassroots level. The unique and pressing needs of rural America, Veterans and military family members, and Rod Baker's "Meaningful Retirement" symposium presentation highlighted areas in which psychology possesses truly unique expertise. On a personal level, I especially appreciated hearing the stories of the profession's leaders – past, present, and future – during which APA President-Elect Rosie Phillips Davis spontaneously joined Recording Secretary Jennifer Kelly and Uniformed Services University (USU) graduate student Fernanda De Oliveira for "Getting Involved in the Policy Process – Challenges, Successes, and Strategies."

Jennifer's presentation, "Strategies for Effective Advocacy in the Passage of Mental Health Legislation," focused on the importance of effective advocacy in raising awareness on mental health issues and ensuring that mental health is on the national agenda of governments. She noted that advocacy on the Federal level is important as the federal government impacts psychology in numerous ways, including the funding of basic, applied, and clinical research; creating and administering social programs critical to the livelihood and health of the people psychologists serve; providing reimbursement for service delivery; and expanding opportunities in psychology education and training. She discussed ways to effectively advocate, such as making phone calls, writing letters and emails; and most importantly, in-person visits with the lawmakers and their staff. Rosie presented her forthcoming Presidential initiative on "Deep Poverty." She is forming a work group to explore the communication patterns that have led to poverty being considered an individual shame rather than a national problem. Her work group will explore how psychologists can use psychological science to partner with cities as mayors explore ways to improve the economic outlook for their citizens. And, they will also explore advocacy options with policy makers, service providers, individuals living in Deep Poverty, and psychologists who want to impact the number of people living in poverty.

As discussant, Fernanda reflected on the recommendations provided by Jennifer and Rosie as they apply to students eager to advocate for their ideas at the institutional level, and commonly expressed barriers to seeing oneself in the role of an advocate within our field. More specifically, she noted how the same self-reflective nature that draws many of us to psychology can also keep us from believing in our capacity to advocate for our ideas and to promote change on behalf of those we serve. She concluded her comments by urging audience members to mentor their juniors on how to develop their identity as advocates of their ideas, knowledge, and profession.

The unprecedented advances occurring within the communications and technology fields, as well as the ever-shifting landscape of our nation's healthcare environment, continue to have a major impact upon society and therefore the profession of psychology. Accordingly, the implications of these developments were present throughout the convention. Presentations on telehealth, including its complex ethical considerations, were especially timely. Fred Millan, Past President of the Association of State and Provincial Psychology Boards (ASPPB); Linda Campbell and Jana Martin, CEO of The Trust, have been providing presentations on telehealth since the APA guidelines were adopted (they were co-chairs of the Task Force creating the guidelines) in 2013. They have an impressive case-oriented style which generates active audience participation. This year they shared scenarios on Confidentiality and Informed Consent. APA's Deborah Baker also participated by discussing legal issues and state telehealth coverage mandates. Not surprisingly, the federal government has long been on the cutting-edge of effectively utilizing telehealth and fostering integrated care, as reflected in symposiums chaired by Chris Kasper, formally at USU and now Dean of the School of Nursing at the University of New Mexico, and Lisa Kearny, Chair of the Board of Professional Affairs (BPA). Both of these evolving initiatives, with their inherent implications for licensure mobility, present intriguing challenges and opportunities for all of the health professions.

Transformative Challenges: Psychology and each of the mental health/ behavioral health professions must come to appreciate the transformational nature of telehealth. A recent communication from a longtime Hawaii colleague, who once again is serving as Director of our Department of Health: "Telehealth could be a valuable tool in evaluating individuals with behavioral issues who are brought to emergency rooms by police officers (i.e., 'MH-1s'). Basically, MH-1s are brought to emergency rooms because they were disruptive and pose a threat to themselves or others. I believe one of the significant barriers to hospitals accepting these individuals is the lack of psychiatrists, psychologists, and other health professionals to evaluate MH-1s quickly and accurately when they are brought in, particularly in rural areas. As a result, only the large hospitals that have psychiatrists and other mental health professionals on staff 24/7 are comfortable taking most of them (i.e., Queen's and Castle). Fortunately, some Neighbor Islands hospitals (e.g., Hilo, Kona, Maui Memorial, KVMH and Kauai Veterans) have found ways, but MH-1s are still considered a strain on limited resources. I believe telehealth would be a great way to assure a timely evaluation, so that the police officer doesn't spend hours attending the person he or she brings into the ER waiting for an evaluation and, of course, it is good for the patient to be evaluated quickly, too. It seems to me that telemedicine, and particularly telepsychiatry, is a potentially terrific tool to expand the availability of mental health services in Hawaii" (Bruce Anderson).

A related, although slightly different perspective, regarding the long term implications of telehealth from a former BPA staff director: "As it continues to unfold, it will challenge the very basis of independent practice as we have known it since the late 1940's. Licenses will cease to limit access to markets and the rationale for state regulation of practice will be called into question. APA's policy infrastructure is not up to this, nor is its politics. As a strong, vocal, and visible advocate for these changes, I would encourage you to remember what happened to your CHAMPUS peer review project. The independent practice folks killed it and ushered in managed care. One would hypothesize the same will happen here. Systems of care will adapt. Private practice will soon see the threat of nationalized companies offering 24/7, 365 days service on demand. Batten down the hatches as we move forward because it's unlikely to be as pretty as your columns suggest" (Dick Kilburg).

The Global Context: One of the most satisfying aspects of working within an academic environment, such as USU, is the daily exposure to intellectual colleagues who appreciate the "bigger picture" and who constantly remind one of the importance of being aware of the values and experiences of those from different professional and cultural backgrounds; i.e., looking beyond perhaps comfortable, but intellectually isolating, "silos." Dale Smith, USU Professor of Military Medicine and History, recently provided "A History of PhD Education" for the newly enrolled Ph.D. students ("2018 Warrior Scholars") at the Daniel K. Inouye Graduate School of Nursing. Emphasizing the revolutionary impact of education upon practice, and vice versa, he quoted Daniel Coit Gilman: "The best teachers are usually those who are free, competent and willing to make original researches in the library and the laboratory."

In 1900, 14 educational institutions joined together to create the Association of American Universities with the laudable goal of ensuring the overall quality of higher education. Psychology's visionary Boulder Conference was held in 1949. In the mid-1960s, the Professional School PsyD concept arrived, shepherded by visionaries Nick Cummings at CSPP, Ron Fox at Wright State University, and Don Peterson at Rutgers University. In the 1950s, nursing moved from its historical, often hospital-based, diploma degree to the BSN standard. By 1970, there were 20 nursing educational institutions granting advanced practice master's degrees; this number increased to 78 institutions by the year 2000. In 2001, the University of Kentucky had established the Doctor of Nursing Practice (DNP) degree. Today, there are 278 DNP programs and approximately 132 nursing programs granting the Ph.D.

As Dale described how nursing's educational standards had evolved over time – especially within the larger societal context -- those with a psychology or clinical pharmacy background could quickly appreciate the similarities with their own profession's maturation. From this perspective, the landmark 2010 Institute of Medicine report The Future of Nursing, which calls for allowing nursing graduates to practice to the full extent of their education and training and to be full partners with physicians and other health care professionals, in fact, reflects both the changing dynamics of education and how educational advances have significantly modified what each health profession's clinical practice is and will be expected to become. Society's very definition of "quality care" has been constantly undergoing significant change. "We all live in a yellow submarine" (The Beatles, 1966).

The Advanced Practice Registered Nurse (APRN) Legislative Experience: When one appreciates that each of the health professions functions within a changing American healthcare environment, the importance of building interprofessional relationships and collaborative legislative coalitions becomes increasingly evident. Carole Myers and Jill Alliman recently published in an American Association of Nurse Practitioners (AANP) journal Updates on the Quest for Full Practice Authority in Tennessee, which is considered one of the most restrictive states in the nation. In 2016, the Tennessee General Assembly established a Scope of Practice Task Force to "make recommendations on the implementation of a plan to allow health care providers to work to the full extent of their education, experience, and training and identify… unnecessary regulations." The authors noted that the resistance to progressive change that they are experiencing in Tennessee is similar to experiences in other restrictive states, many of which are located in the Southeastern United States. Advancing full practice authority will require new strategies.

Their Task Force met four times and polarization between the physician and nurse members was apparent from the first meeting. The physicians attempted to draw attention away from the assigned objectives by utilizing distractions and distortions. They assaulted the adequacy of APRN education; dismissed evidence of cost, quality, effectiveness, and acceptability of APRN-provided care; denied health care access problems existed; and, blamed APRN prescribers for the state's prescription drug abuse epidemic. Attempts by the nursing members to respond to these tactics with evidence and logic proved ineffective at dispelling misconceptions and false statements. If evidence-based medicine was to be the acceptable standard of care, then actual care should be evaluated using clinical and patient-satisfaction outcomes, not the number of years of education. Perhaps physicians are, in fact, over-prepared to deliver the majority of direct primary care services and are better suited to roles related to population health management and caring for populations with complex needs. Simply stated, the physicians refused to recognize the evidence presented by nursing during the Task Force proceedings.

The key lessons learned: * It is imperative to engage nurses and stakeholders from non-nursing sectors, including business and industry. * Evidence is a beginning and a means, but not an end. It is important that evidence be translated into an easy-to-understand, effective message that resonates with stakeholders and motivates them to act. * Unity is powerful. In the past, there have been numerous efforts by a variety of organizations to divide nurses. And, * Full practice authority is primarily about access to high-quality, cost-effective care that honors patients' choice of providers. The motivation and discussion on full practice authority must remain patient-centered. Those dedicated to psychology's prescriptive authority (RxP) agenda should not be surprised to learn that Bethe Lonning reports that at their Administrative Rules Review Committee meeting for the Iowa legislature, the lobbyist for the Iowa Psychiatric Society spoke in the public comment section to indicate that her members had concerns about the education and training of potential RxP psychologists, as written in the proposed rules. Aloha,

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



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ALOHA - Division 29 August column

“I LEFT MY HEART IN SAN FRANCISCO”

The 12,300+ colleagues who attended the 126^th annual APA convention in San Francisco were especially fortunate to be gently reminded, especially during the remarkable Opening Session, why we had chosen psychology many years ago.  The Keynote address by Attorney Bryan Stevenson provided an emotionally moving glimpse into the lives of those caught up within the criminal justice system – especially children – who have historically been “powerless.”  Advancing social justice clearly remains a high priority for many of those in attendance.  Throughout the convention, the personal stories of President Jessica Henderson Daniel’s Citizen Psychologists provided an awesome appreciation for how individuals can make a real difference in the lives of our nation’s citizens at the grassroots level.  The unique and pressing needs of rural America, Veterans and military family members, and Rod Baker’s “Meaningful Retirement” symposium presentation highlighted areas in which psychology possesses truly unique expertise.  On a personal level, I especially appreciated hearing the stories of the profession’s leaders – past, present, and future – during which APA President-Elect Rosie Phillips Davis spontaneously joined Recording Secretary Jennifer Kelly and Uniformed Services University (USU) graduate student Fernanda De Oliveira for “Getting Involved in the Policy Process – Challenges, Successes, and Strategies.”

Jennifer’s presentation, “Strategies for Effective Advocacy in the Passage of Mental Health Legislation,” focused on the importance of effective advocacy in raising awareness on mental health issues and ensuring that mental health is on the national agenda of governments.  She noted that advocacy on the Federal level is important as the federal government impacts psychology in numerous ways, including the funding of basic, applied, and clinical research; creating and administering social programs critical to the livelihood and health of the people psychologists serve; providing reimbursement for service delivery; and expanding opportunities in psychology education and training.  She discussed ways to effectively advocate, such as making phone calls, writing letters and emails; and most importantly, in-person visits with the lawmakers and their staff.  Rosie presented her forthcoming Presidential initiative on “Deep Poverty.”  She is forming a work group to explore the communication patterns that have led to poverty being considered an individual shame rather than a national problem.  Her work group will explore how psychologists can use psychological science to partner with cities as mayors explore ways to improve the economic outlook for their citizens.  And, they will also explore advocacy options with policy makers, service providers, individuals living in Deep Poverty, and psychologists who want to impact the number of people living in poverty.

As discussant, Fernanda reflected on the recommendations provided by Jennifer and Rosie as they apply to students eager to advocate for their ideas at the institutional level, and commonly expressed barriers to seeing oneself in the role of an advocate within our field.  More specifically, she noted how the same self-reflective nature that draws many of us to psychology can also keep us from believing in our capacity to advocate for our ideas and to promote change on behalf of those we serve.  She concluded her comments by urging audience members to mentor their juniors on how to develop their identity as advocates of their ideas, knowledge, and profession.

The unprecedented advances occurring within the communications and technology fields, as well as the ever-shifting landscape of our nation’s healthcare environment, continue to have a major impact upon society and therefore the profession of psychology.  Accordingly, the implications of these developments were present throughout the convention.  Presentations on telehealth, including its complex ethical considerations, were especially timely.  Fred Millan, Past President of the Association of State and Provincial Psychology Boards (ASPPB); Linda Campbell and Jana Martin, CEO of The Trust, have been providing presentations on telehealth since the APA guidelines were adopted (they were co-chairs of the Task Force creating the guidelines) in 2013.  They have an impressive case-oriented style which generates active audience participation.  This year they shared scenarios on Confidentiality and Informed Consent.  APA’s Deborah Baker also participated by discussing legal issues and state telehealth coverage mandates.  Not surprisingly, the federal government has long been on the cutting-edge of effectively utilizing telehealth and fostering integrated care, as reflected in symposiums chaired by Chris Kasper, formally at USU and now Dean of the School of Nursing at the University of New Mexico, and Lisa Kearny, Chair of the Board of Professional Affairs (BPA).  Both of these evolving initiatives, with their inherent implications for licensure mobility, present intriguing challenges and opportunities for all of the health professions.

Transformative Challenges:  Psychology and each of the mental health/ behavioral health professions must come to appreciate the transformational nature of telehealth.  A recent communication from a longtime Hawaii colleague, who once again is serving as Director of our Department of Health:  “Telehealth could be a valuable tool in evaluating individuals with behavioral issues who are brought to emergency rooms by police officers (i.e., ‘MH-1s’).  Basically, MH-1s are brought to emergency rooms because they were disruptive and pose a threat to themselves or others.  I believe one of the significant barriers to hospitals accepting these individuals is the lack of psychiatrists, psychologists, and other health professionals to evaluate MH-1s quickly and accurately when they are brought in, particularly in rural areas.  As a result, only the large hospitals that have psychiatrists and other mental health professionals on staff 24/7 are comfortable taking most of them (i.e., Queen’s and Castle).  Fortunately, some Neighbor Islands hospitals (e.g., Hilo, Kona, Maui Memorial, KVMH and Kauai Veterans) have found ways, but MH-1s are still considered a strain on limited resources.  I believe telehealth would be a great way to assure a timely evaluation, so that the police officer doesn’t spend hours attending the person he or she brings into the ER waiting for an evaluation and, of course, it is good for the patient to be evaluated quickly, too.  It seems to me that telemedicine, and particularly telepsychiatry, is a potentially terrific tool to expand the availability of mental health services in Hawaii” (Bruce Anderson).

A related, although slightly different perspective, regarding the long term implications of telehealth from a former BPA staff director: “As it continues to unfold, it will challenge the very basis of independent practice as we have known it since the late 1940’s.  Licenses will cease to limit access to markets and the rationale for state regulation of practice will be called into question.  APA’s policy infrastructure is not up to this, nor is its politics.  As a strong, vocal, and visible advocate for these changes, I would encourage you to remember what happened to your CHAMPUS peer review project.  The independent practice folks killed it and ushered in managed care.  One would hypothesize the same will happen here.  Systems of care will adapt.  Private practice will soon see the threat of nationalized companies offering 24/7, 365 days service on demand.  Batten down the hatches as we move forward because it’s unlikely to be as pretty as your columns suggest” (Dick Kilburg).

            The Global Context:  One of the most satisfying aspects of working within an academic environment, such as USU, is the daily exposure to intellectual colleagues who appreciate the “bigger picture” and who constantly remind one of the importance of being aware of the values and experiences of those from different professional and cultural backgrounds; i.e., looking beyond perhaps comfortable, but intellectually isolating, “silos.”  Dale Smith, USU Professor of Military Medicine and History, recently provided “A History of PhD Education” for the newly enrolled Ph.D. students (“2018 Warrior Scholars”) at the Daniel K. Inouye Graduate School of Nursing.   Emphasizing the revolutionary impact of education upon practice, and vice versa, he quoted Daniel Coit Gilman: “The best teachers are usually those who are free, competent and willing to make original researches in the library and the laboratory.”

In 1900, 14 educational institutions joined together to create the Association of American Universities with the laudable goal of ensuring the overall quality of higher education.  Psychology’s visionary Boulder Conference was held in 1949.  In the mid-1960s, the Professional School PsyD concept arrived, shepherded by visionaries Nick Cummings at CSPP, Ron Fox at Wright State University, and Don Peterson at Rutgers University.  In the 1950s, nursing moved from its historical, often hospital-based, diploma degree to the BSN standard.  By 1970, there were 20 nursing educational institutions granting advanced practice master’s degrees; this number increased to 78 institutions by the year 2000.  In 2001, the University of Kentucky had established the Doctor of Nursing Practice (DNP) degree.  Today, there are 278 DNP programs and approximately 132 nursing programs granting the Ph.D.

As Dale described how nursing’s educational standards had evolved over time – especially within the larger societal context -- those with a psychology or clinical pharmacy background could quickly appreciate the similarities with their own profession’s maturation.  From this perspective, the landmark 2010 Institute of Medicine report The Future of Nursing, which calls for allowing nursing graduates to practice to the full extent of their education and training and to be full partners with physicians and other health care professionals, in fact, reflects both the changing dynamics of education and how educational advances have significantly modified what each health profession’s clinical practice is and will be expected to become.  Society’s very definition of “quality care” has been constantly undergoing significant change.  “We all live in a yellow submarine” (The Beatles, 1966).

            The Advanced Practice Registered Nurse (APRN) Legislative Experience:  When one appreciates that each of the health professions functions within a changing American healthcare environment, the importance of building interprofessional relationships and collaborative legislative coalitions becomes increasingly evident.  Carole Myers and Jill Alliman recently published in an American Association of Nurse Practitioners (AANP) journal Updates on the Quest for Full Practice Authority in Tennessee, which is considered one of the most restrictive states in the nation.  In 2016, the Tennessee General Assembly established a Scope of Practice Task Force to “make recommendations on the implementation of a plan to allow health care providers to work to the full extent of their education, experience, and training and identify… unnecessary regulations.”  The authors noted that the resistance to progressive change that they are experiencing in Tennessee is similar to experiences in other restrictive states, many of which are located in the Southeastern United States.  Advancing full practice authority will require new strategies.

            Their Task Force met four times and polarization between the physician and nurse members was apparent from the first meeting.  The physicians attempted to draw attention away from the assigned objectives by utilizing distractions and distortions.  They assaulted the adequacy of APRN education; dismissed evidence of cost, quality, effectiveness, and acceptability of APRN-provided care; denied health care access problems existed; and, blamed APRN prescribers for the state’s prescription drug abuse epidemic.  Attempts by the nursing members to respond to these tactics with evidence and logic proved ineffective at dispelling misconceptions and false statements.  If evidence-based medicine was to be the acceptable standard of care, then actual care should be evaluated using clinical and patient-satisfaction outcomes, not the number of years of education.  Perhaps physicians are, in fact, over-prepared to deliver the majority of direct primary care services and are better suited to roles related to population health management and caring for populations with complex needs.  Simply stated, the physicians refused to recognize the evidence presented by nursing during the Task Force proceedings.

            The key lessons learned: * It is imperative to engage nurses and stakeholders from non-nursing sectors, including business and industry.  * Evidence is a beginning and a means, but not an end.  It is important that evidence be translated into an easy-to-understand, effective message that resonates with stakeholders and motivates them to act.  * Unity is powerful.  In the past, there have been numerous efforts by a variety of organizations to divide nurses.  And, * Full practice authority is primarily about access to high-quality, cost-effective care that honors patients’ choice of providers.  The motivation and discussion on full practice authority must remain patient-centered.  Those dedicated to psychology’s prescriptive authority (RxP) agenda should not be surprised to learn that Bethe Lonning reports that at their Administrative Rules Review Committee meeting for the Iowa legislature, the lobbyist for the Iowa Psychiatric Society spoke in the public comment section to indicate that her members had concerns about the education and training of potential RxP psychologists, as written in the proposed rules.  Aloha,

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