Aloha - DIVISION 55

“ODE TO JOY”

            Earlier this year our visionary leader Ron Fox left us after a short heroic battle with cancer.  A number of us had the opportunity to visit with him during those final weeks and were extraordinarily moved by his continuing passion for the many contributions that psychology can make to our nation.  The establishment of Division 55 was but one of Ron’s many “gifts” to the field.  Former APA President Tony Puente was able to personally present him with a special Presidential Citation and they discussed APA’s renewed organizational efforts to become more effective legislatively.

“One of the unique opportunities that has arisen with the difficulties APA has encountered in recent years is that of rebuilding and transforming itself.  With the unusual demands and chaos in the public arena, especially with political and social issues, APA’s leadership took the special step of reconsidering the role of advocacy within the organization.  APA is comprised of two organizations – one for psychology (c3) and one for psychologists (c6).  The former is what most of us know about APA and what APA has been for 125 years.  The latter is primarily comprised of the APA Practice Organization, devoted to the profession of psychology.  After much research, thought and deliberation it was evident to us that the role and funding of the APA Practice Organization had run its course based on the foundation of its pioneering vision emerging during the late 1980s.  This year the Council of Representatives, after much vetting, decided to pass an historic agenda item empowering a new vision for all aspects of the profession of psychologists – not just clinicians; but scientists, professors, public interest as well as applied psychologists.  This new entity, APA Psychological Services, will now begin a robust and exhaustive advocacy program that is well funded, integrated and essentially limitless.  The Association has recently put out a call for nominees to be part of the inaugural Advocacy Coordinating Committee which will be convened on January 1, 2019.  This group will begin to study and prioritize APA’s advocacy agenda.  I am pleased to report that Ron was very supportive of this evolution and highly engaged during our discussions” (Tony Puente).

One of Ron’s special attributes was his capacity to serve as a mentor for decades of colleagues, including a number of us serving with him on the Board of Directors and the Division.  “Ron, who was instrumental in creating the School of Professional Psychology (SOPP) at Wright State University, valued deeply the education and training of psychologists.  Consequently it is no surprise that SOPP was awarded the first grant by the APA Committee for the Advancement of Professional Psychology (CAPP) to develop a curriculum for the training that would be needed to support prescriptive authority.  As a faculty member during that time I had the wonderful opportunity to work on this grant, together with our Dean for Academic Affairs Alan Barclay.  As we all know, Ron was never at a loss for words, usually capturing in the most succinct way the essence of the issue.  And so it was when it came to psychologists and prescribing.  In one of our conversations, as we discussed the most recent vocal opposition by other psychologists to the idea, Ron commented how psychologists certainly were capable of learning!  So, not to even explore the idea – yes, he saw they were objecting to the idea – in his view was being ‘anti-intellectual!’  Our profession has lost not only a visionary, but a voice of wisdom.  Aloha” (Kathy McNamara).

“I spoke with Ron by phone shortly before he passed.  I was aware that he had many calls and visits earlier.  We talked for well over an hour, maybe two.  Judy scheduled the time.  Given his illness, I was surprised how much time he was able to talk.  But I was so glad to be able to speak with him.  He talked about his memories of our time working together at Wright State (1983-1992).  I listened.

“Among other things, he reminisced about our times at SOPP and the many accomplishments.  We had both come to Wright State after working as psychologists within Schools of Medicine (Meharry and Ohio State).  The circumstances at Wright State provided an extraordinary opportunity for both of us professionally and for psychology as a profession.  For example, the structure of the School of Professional Psychology existed on an equal level with the University’s Schools of Medicine and Nursing.  This meant that the Dean of the School had a direct reporting relationship to the University Provost and as well sometimes to the University President.  This had important implications for the School’s budget since it would not compete with the numerous departments (including the Psychology Department in the Liberal Arts College) and other programs within the University for allocations and controls.  Among other things this added tremendous status to Psychology as an independent health profession, (i.e., not subordinate to psychiatry).

“Ron spoke proudly about the many students who trained at SOPP and who went on to successful careers.  He was very proud of our success in identifying talented minority trainees as well as their career successes.  He was also proud of our successes in obtaining federal grants for the School from NIMH, the HHS Health Care Opportunity grant program, and the Maternal and Child Health Bureau which at the time was unique for PsyD programs.  We were also successful in obtaining support from the Ohio Department of Mental Health and the Department of Health Office of Minority Health.  I remember him saying at the end: ‘Looking back on it all Rod, we did great work there….’  That meant a lot to me…” (Rod Hammond).

            One of Ron’s most enduring efforts was to significantly increase the governance and policy involvement of psychology’s female and ethnic minority members.  As has often been the case, Ron was decades ahead of his colleagues.  Jacque Gray, a Choctaw and Cherokee descendent, has been working with her Native American colleagues to get as many Early Career Native Americans elected and appointed to various APA Boards, Committees, and Task Forces.  As an Associate Editor of the Division 18 journal Psychological Services, she has been outstanding in bringing their unique perspective to the attention of public service psychologists – including those serving within the military, VA, and Indian Health Service.  “The Society of Indian Psychologists’ Commentary on the APA Ethical Principles of Psychologists and Code of Conduct was published and has contributed to APA’s understanding of ethics in a cultural context.  In 2015, there were only 10 Native American Fellows of APA and rarely were any indigenous psychologists recognized for their accomplishments by APA.  Since that time we have increased the number of APA Fellows by 50% and in 2018, 12 APA awards went to indigenous psychologists.  Division 45 now has the Trimble Horvat Awards for a senior psychologist and a student to acknowledge contributions to Native or Indigenous Psychology.  In 2016, Division 45 Presidential initiatives focused upon contributions to psychology by Native Americans.  These accomplishments include Networking Theory developed by Carolyn Atteneave, Maslow taking his hierarchy of needs from the Blackfeet/Blood tribes of Montana and Canada, Jung going to the Hopi to learn about dream interpretation, Erickson learning about child rearing practices from the Lakota, and Sherif and Sherif taking over a project from three Native American graduate students at Robbers’ Cave and never mentioning them.  It is important for these contributions to be acknowledged and taught in psychology courses” (Jacque Gray).”

            In our judgment, over the past several years, APA Board of Directors’ member Beth Rom-Rymer has probably done more than any other single individual to revitalize Ron’s vision for prescriptive authority (RxP).  The Illinois Psychological Association’s stunning 2014 legislative RxP success, under her leadership, after nearly a decade of inactivity at the state level, is simply monumental.  Beth truly appreciates the importance of Ron’s commitment to the next generation and I have been pleased to serve as a reviewer for her American Psychological Foundation (APF) RxP scholarship submissions, as well as participate in her various Windy City networking dinners, convening those actively seeking clinical psychopharmacology training and those who are committed to providing training for prescribing psychologists.  These often include colleagues from the county, state, and federal sectors.  Because she has made it a priority to participate on the Boards of mental health and educational institutions, in Illinois, major stakeholders have jumped in to support the training of prescribing psychologists.  Most recently, Beth is partnering with AMITA Health, which is the third largest health system in Illinois, to create an innovative program of Graduate Psychology Assistantships in The Advancement of RxP Training.

“AMITA Health, with nine hospitals, 80 clinics and outpatient facilities, and more than 3,000 hospital-affiliated physicians, is expanding its residency training opportunities for prescribing psychologists by hiring two advanced graduate students, per year, at 20 hours/week, with significant stipends, to assist the organization of the residency training in the state-required medical rotations; assist in broadening of the residency training to accommodate the needs of psychology interns and post-docs; assist in the creation of a statewide residency program model that prepares its trainees for a superior level of prescriptive practice; assist in the lobbying efforts to expand the scope of practice of the Illinois Prescriptive Authority statute; and, to become involved in a comprehensive research program that will assess the effectiveness of prescribing psychologists, an oft-requested and much needed initiative.

            “Another hospital system, based in the neighboring state of Indiana, is excited about the opportunity to integrate prescribing psychologist training into its existing medical residency program.  This system is considering offering a substantial salary to psychology residents, while they pursue their medical residency program and take their place on its faculty roster.  [Recall that in 1993 Mike Murphy was successful in amending the Indiana psychology statute to include prescribing; notwithstanding, his Hoosier colleagues have yet to develop an effective implementation plan.]  Other new rotation training sites, under discussion, include the Illinois state and county correctional systems; a community-based (and internationally recognized) healthcare clinic for, primarily, LBGTQ residents; the largest and oldest social service organization in Illinois; and a trauma center in one of Chicago’s internationally renowned medical institutions” (Beth Rom-Rymer).

            Another Exciting Training Program Opening Up:  “Idaho State University Department of Pharmacy is finalizing the curriculum of their two year, brick and mortar, Psychopharmacology Master’s program.  We are in the final stages of interviewing candidates for the director of training position.  The plan is to accept students for the 2019-2020 academic year.  We continue to be very interested in serving as a military post-doctoral training site and are working to expand our DOD outreach.  Great things are happening!” (Page Haviland).  Aloha, (German poet, playwright, and historian Friedrich Schiller, 1785).

Pat DeLeon, former APA President – Division 55 – October, 2018

SIGNIFICANT CHANGE IS IN THE WINDS

APA's 126th Annual Convention: San Francisco is always a delightful place to visit. This year I was particularly pleased to see the extent to which active duty colleagues were actively participating in the convention, especially those from the Uniformed Services University (USU). Jeff Goodie, CAPT. USPHS, gave a wonderful APF Rosalee G. Weiss Award Lecture on "Integrated Behavioral Health in Primary Care and in Communities Following Tragedies: Lessons Learned." A former USAF psychologist, Jeff vividly described how interprofessional teams were making a real difference in the lives of those impacted by Sandy Hook, Hurricane Katrina, and the utter devastation of Puerto Rico. Under his leadership, third year and higher psychology students at USU observe Family Medicine clerkship students during their interview with standardized patients and then provide structured feedback to the medical students about their communication skills. Personally, I was especially honored to be asked by former Division 19 President Sally Harvey to participate in her symposium "The Many Faces of Operational Psychology." My message was quite straightforward: APA should honor these colleagues who are willing to "place themselves in harm's way" and appreciate their critical and lasting contributions to the nation.

Transforming the Profession: The Departments of Defense (DOD) and Veterans Affairs (VA) have an impressive history of initiating transformational change within the nation's federal health care system. Whether one reflects upon former Army Surgeon General Patty Horoho's emphasis upon wellness and behavioral health, the importance of team-based integrated care as described by Jeff, the decision by former VA Secretary David Shulkin to establish a national scope of practice for Advanced Practice Registered Nurses (APRNs), or the utility of prescribing psychologists (RxP), each of these initiatives has foreshadowed visionary developments occurring within our nation's overall health care environment.

In many ways, the demonstrated federal commitment to developing effective telehealth capacities will ultimately revolutionize the delivery of quality care to those living in austere environments worldwide. As is always the case with major change, advances are built upon foundations established over time. Former Army Surgeon General, and now USU Professor, Eric Shoomaker: "The visionaries in telehealth were Alcide LaNoue as Army SG, Tripler Army Medical Center with Akamai, and the folks at the Telemedicine and Advanced Technology Research Center in USAMRMC – especially Ron Poropatich. Ron placed telemedicine in the Balkans, into Iraq, into Afghanistan and gave us the experience/confidence for me to start up the Hawaii-Ft. Lewis tele-mental health project. The real impetus there was provided in around 2009-2010 by then-BG Steve Jones (now MG [ret]) who demonstrated the ready utility and acceptance of using psychologists and psychiatrists in interviewing redeploying soldiers across thousands of miles. It set a new large-scale practice, in some ways similar to that initial tele-counseling program between WRAMC ('Walter Reed Classic') and outlying posts like Carlisle Barracks, decades before." As one might imagine, telemedicine has had considerable Congressional support over the years.

Significant Change Is Coming: Included in this year's DOD reauthorization and VA appropriations legislation are a number of provisions which signal that the Congress clearly expects readiness-oriented, interprofessional, and increasingly joint efforts to provide timely quality care. Traditional, isolated "silo" approaches will no longer be acceptable.

· The Secretary of Defense shall, acting through the Defense Health Agency, implement an organizational framework for the military healthcare system that most effectively maximizes interoperability and fully integrates medical capabilities of the Armed Forces to enhance joint military medical operations.
· Mental Health -- The conference provides an increase of $16,128,000 above the budget request for mental health programs, including suicide prevention outreach. The conferees urge VA to increase support for primary care-mental health integration and recovery models, expand telemental health services, build on success of evidence-based psychotherapy initiatives, and guide treatment decisions by measuring the outcomes of interventions.
· The VA is directed to work with OPM to create an Occupational Series for Licensed Professional Mental Health Counselors and Marriage and Family Therapists and to create a staffing plan to fill such open positions and assess shortages.
· VA is encouraged to consider the expanded use of doctors of osteopathic medicine, physician assistants, and nurse practitioners to help address any rural health provider gap. Any such gap may be further mitigated through the use of telehealth for medical services.
· Telemedicine – The conference agreement includes $30,000,000 above the budget request for telehealth capabilities and expects a report specifying measures being taken to expand telehealth and telemental health capabilities in rural areas, including ongoing collaboration with other Federal agencies.
· Women's health – The conferees note that the number of female veterans continues to increase and provide $10,000,000 above the budget request for gender-specific care and for the continuing redesign of VA's women's healthcare delivery system and facilities to ensure women receive equitable, timely, and high-quality care.
· Advanced Practice Registered Nurses – The Secretary is urged to work with facilities that have not yet implemented VA's final rule granting full practice authority to advanced practice registered nurses to ensure quick implementation. And,
· VA is directed to ensure that any non-VA physician contracted to conduct medical disability examinations have a current unrestricted license to practice as a physician and is not barred from practicing in any State, DC, etc.

Intriguing Potential for Qualitative Change: At least eight Democratic physicians are running for the U.S. Congress as first-time candidates this election cycle. Of the 11 Democratic physicians running for office, all but one is seeking a seat in the House of Representatives. Currently, there are 14 physicians serving in the Congress, 12 of whom are Republicans. Today only 19% of federal lawmakers are Veterans – the same percentage that are women – with at least 28 female Veterans seeking House seats and four vying for the Senate. A graduate of the USU School of Medicine will be on the ballot, a former Navy radiologist. The Psychology Times recently highlighted the candidacy of Tammy Savoie, a licensed Louisiana psychologist and retired USAF Lt Col. who is seeking to join Representatives Judy Chu and Alan Lowenthal. With Honor, a super-PAC focused on electing Veterans to Congress, recently received a $10 million contribution. This year APA lost one of its true visionaries with the passing of Past President Ron Fox. Ron dedicated his life to psychology and APA. Hopefully, members of the Division will seriously consider running for elected office within APA and the public sector in the near future in furtherance of his vision. Aloha,

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


Sent from my iPhone

ALOHA

SIGNIFICANT CHANGE IS IN THE WINDS

            APA’s 126^th Annual Convention:  San Francisco is always a delightful place to visit.  This year I was particularly pleased to see the extent to which active duty colleagues were actively participating in the convention, especially those from the Uniformed Services University (USU).  Jeff Goodie, CAPT. USPHS, gave a wonderful APF Rosalee G. Weiss Award Lecture on “Integrated Behavioral Health in Primary Care and in Communities Following Tragedies: Lessons Learned.”  A former USAF psychologist, Jeff vividly described how interprofessional teams were making a real difference in the lives of those impacted by Sandy Hook, Hurricane Katrina, and the utter devastation of Puerto Rico.  Under his leadership, third year and higher psychology students at USU observe Family Medicine clerkship students during their interview with standardized patients and then provide structured feedback to the medical students about their communication skills.  Personally, I was especially honored to be asked by former Division 19 President Sally Harvey to participate in her symposium “The Many Faces of Operational Psychology.”  My message was quite straightforward: APA should honor these colleagues who are willing to “place themselves in harm’s way” and appreciate their critical and lasting contributions to the nation.

            Transforming the Profession:  The Departments of Defense (DOD) and Veterans Affairs (VA) have an impressive history of initiating transformational change within the nation’s federal health care system.  Whether one reflects upon former Army Surgeon General Patty Horoho’s emphasis upon wellness and behavioral health, the importance of team-based integrated care as described by Jeff, the decision by former VA Secretary David Shulkin to establish a national scope of practice for Advanced Practice Registered Nurses (APRNs), or the utility of prescribing psychologists (RxP), each of these initiatives has foreshadowed visionary developments occurring within our nation’s overall health care environment.

In many ways, the demonstrated federal commitment to developing effective telehealth capacities will ultimately revolutionize the delivery of quality care to those living in austere environments worldwide.  As is always the case with major change, advances are built upon foundations established over time.  Former Army Surgeon General, and now USU Professor, Eric Shoomaker: “The visionaries in telehealth were Alcide LaNoue as Army SG, Tripler Army Medical Center with Akamai, and the folks at the Telemedicine and Advanced Technology Research Center in USAMRMC – especially Ron Poropatich.  Ron placed telemedicine in the Balkans, into Iraq, into Afghanistan and gave us the experience/confidence for me to start up the Hawaii-Ft. Lewis tele-mental health project.  The real impetus there was provided in around 2009-2010 by then-BG Steve Jones (now MG [ret]) who demonstrated the ready utility and acceptance of using psychologists and psychiatrists in interviewing redeploying soldiers across thousands of miles.  It set a new large-scale practice, in some ways similar to that initial tele-counseling program between WRAMC (‘Walter Reed Classic’) and outlying posts like Carlisle Barracks, decades before.”  As one might imagine, telemedicine has had considerable Congressional support over the years.

Significant Change Is Coming:  Included in this year’s DOD reauthorization and VA appropriations legislation are a number of provisions which signal that the Congress clearly expects readiness-oriented, interprofessional, and increasingly joint efforts to provide timely quality care.  Traditional, isolated “silo” approaches will no longer be acceptable.

·         The Secretary of Defense shall, acting through the Defense Health Agency, implement an organizational framework for the military healthcare system that most effectively maximizes interoperability and fully integrates medical capabilities of the Armed Forces to enhance joint military medical operations.

·         Mental Health -- The conference provides an increase of $16,128,000 above the budget request for mental health programs, including suicide prevention outreach.  The conferees urge VA to increase support for primary care-mental health integration and recovery models, expand telemental health services, build on success of evidence-based psychotherapy initiatives, and guide treatment decisions by measuring the outcomes of interventions.

·         The VA is directed to work with OPM to create an Occupational Series for Licensed Professional Mental Health Counselors and Marriage and Family Therapists and to create a staffing plan to fill such open positions and assess shortages.

·         VA is encouraged to consider the expanded use of doctors of osteopathic medicine, physician assistants, and nurse practitioners to help address any rural health provider gap.  Any such gap may be further mitigated through the use of telehealth for medical services.

·         Telemedicine – The conference agreement includes $30,000,000 above the budget request for telehealth capabilities and expects a report specifying measures being taken to expand telehealth and telemental health capabilities in rural areas, including ongoing collaboration with other Federal agencies.

·         Women’s health – The conferees note that the number of female veterans continues to increase and provide $10,000,000 above the budget request for gender-specific care and for the continuing redesign of VA’s women’s healthcare delivery system and facilities to ensure women receive equitable, timely, and high-quality care.

·         Advanced Practice Registered Nurses – The Secretary is urged to work with facilities that have not yet implemented VA’s final rule granting full practice authority to advanced practice registered nurses to ensure quick implementation.  And,

·         VA is directed to ensure that any non-VA physician contracted to conduct medical disability examinations have a current unrestricted license to practice as a physician and is not barred from practicing in any State, DC, etc.

            Intriguing Potential for Qualitative Change:  At least eight Democratic physicians are running for the U.S. Congress as first-time candidates this election cycle.  Of the 11 Democratic physicians running for office, all but one is seeking a seat in the House of Representatives.  Currently, there are 14 physicians serving in the Congress, 12 of whom are Republicans.  Today only 19% of federal lawmakers are Veterans – the same percentage that are women – with at least 28 female Veterans seeking House seats and four vying for the Senate.  A graduate of the USU School of Medicine will be on the ballot, a former Navy radiologist.  The Psychology Times recently highlighted the candidacy of Tammy Savoie, a licensed Louisiana psychologist and retired USAF Lt Col. who is seeking to join Representatives Judy Chu and Alan Lowenthal.  With Honor, a super-PAC focused on electing Veterans to Congress, recently received a $10 million contribution.  This year APA lost one of its true visionaries with the passing of Past President Ron Fox.  Ron dedicated his life to psychology and APA.  Hopefully, members of the Division will seriously consider running for elected office within APA and the public sector in the near future in furtherance of his vision.  Aloha,

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

MEANINGFUL STEPS, STEADY PROGRESS

The weekend following APA's 126th Annual Convention in San Francisco, I had the opportunity to attend Beth Rom-Rymer's Fifth Biannual Prescriptive Authority (RxP) Networking dinner in the Windy City, where our 127th Annual Convention will be held. "'You have a moment, a moment in which you can have psychologists prescribing in Illinois. Or, you can walk away and close the door. The resources spent would be lost. Another opportunity may come, but it is beyond what the eye can see.'" On August 18, 2018, more than four years after those words were spoken, 115 psychologists, attorneys, hospital CEO's, chiefs of psychiatry, and graduate and undergraduate students attended an RxP dinner networking event in my home. APA CEO Arthur Evans; Pat; and internationally renowned trauma researcher, Stevan Hobfoll, were the keynote speakers. Also speaking were the six psychologists who are currently doing their medical residency training, one of the three required elements for prescriptive authority licensure in Illinois.

"In Illinois, two psychologists have now applied for a prescribing psychologist's license. Six psychologists are well-ensconced in their residency training (nine medical rotations, at 20 or 30 hours a week, over a period of no less than 14 months) in four of the more than 50 major medical centers in Illinois. Over 40 practicing psychologists are pursuing their Master's degree in Clinical Psychopharmacology or studying for their capstone exam, the Psychopharmacological Exam for Psychologists (PEP-2). Ten graduate students are pursuing their Master's degrees in Clinical Psychopharmacology while pursuing their doctorate degrees in psychology. And, 75 undergraduate students at The University of Illinois, Champaign-Urbana, have declared a 'concentration' in the 'pre-emerging psychology' undergraduate curriculum, which consists of the traditional required undergraduate psychology courses and the seven basic non-psychology science courses, required in the 2014 Prescriptive Authority Illinois statute.

"The Chicago School of Professional Psychology is currently the only institution in the country to offer graduate students the opportunity to take a joint degree in Clinical Psychopharmacology, while studying for the doctorate in Psychology. The students, who are taking the Master's of Science degrees at The Chicago School, are pursuing their doctorate degrees at that school as well as at other professional psychology schools and Universities in Illinois. The Chicago School can offer this training because Illinois is unique, among all of the prescribing states, in that its prescribing statute allows graduate/predoctoral students to take the joint degree. We have built our model upon the foundation provided by my visionary colleague, Lenora Walker, at Nova Southeastern University, several years ago.

"Pursuant to an August 1996 APA Council of Representatives decision, psychologists have been required to have graduated from a doctoral program in psychology; hold a current state license as a psychologist; practice as a 'health services provider,' as defined by state law and/or APA; in order to begin their training toward a prescribing psychologist license. The APA Designation Committee for Postdoctoral Education and Training Programs in Psychopharmacology for Prescriptive Authority has made a recommendation in its 2018 report to Council, that APA offer approval to Psychopharmacology training programs that include predoctoral graduate students. The APA Council will review this Report in 2019. Graduate students in Illinois are thrilled about the opportunity to broaden their course of study, while in graduate school, just as students have benefited from doing joint degrees in medicine, law, business, and nursing, throughout the last half-century.

"Four years ago, we were balancing on the precipice. Today, licensed clinical psychologists, as well as psychology undergraduate and graduate students, are undergoing rigorous training to become prescribing psychologists. Having made the decision to go forward, Illinois psychologists are making history by creating significant changes in the delivery of mental healthcare services in Illinois" (Beth Rom-Rymer, APA Board of Directors).

Substantive change always takes time. Back in 1992, the APA Task Force on Prescriptive Authority, chaired by Mick Smyer, proffered: "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 (and has) the potential to dramatically improve patient care and make important new advances in treatment."

While listening to National Public Radio (NPR) the weekend after Beth's exciting soirée, I heard a familiar voice addressing the complex behavioral health issues surrounding adolescent gaming. It was none other than David Greenfield, who had attended Beth's event, describing his Center for Internet and Technology Addiction perspective. "I recently had the pleasure of being interviewed on my favorite media forum – NPR. Perhaps this may reveal something of my sociopolitical leanings, but that aside, I really enjoy the depth of being able to explore the issues at hand. This was my most recent of about a half-dozen NPR interviews on Internet, Video Game, and Technology addiction. This show focused on the oft-debated discussion of the diagnostic validity of this newly-minted psychological diagnosis by the World Health Organization (WHO) for mid-year inclusion in the ICD-11 as 'Video Gaming Disorder.' The show's focus was on whether or not there is, indeed, such a disorder at all, and its scientific basis or lack thereof.

"My opinion has always been informed from the perspective of a practicing clinician primarily. Although I have done research and written quite a bit on the subject, my perspective is that I didn't invent the disorder, rather the disorder came to me – patients suffering from issues related to their video game use have been coming to me for treatment over the last 20 years (long before DSM's provisional status and the recent WHO inclusion). As psychologists we are ethically responsible to help alleviate human pain, suffering, and dysfunction. And yes, while it is true that the jury may still be out on the exact nature, definition, and treatment of this disorder, the fact remains that there is an impactful set of symptoms that many people are experiencing. While it is important as scientists to get our diagnostic definitions and nosology correct, it is also both unethical and impractical to ask our patients to leave our offices and return only after we have worked out all the diagnostic kinks. Frankly, I am not sure I even care what we call it. I just know I have been treating it long before we had a diagnosis on the horizon, and although I am glad we are researching this topic more thoroughly, I still need to care for those patients suffering now."

David's presentation brought back fond memories of another APA visionary, former Practice Directorate Executive Director Russ Newman. In March, 2006 at the annual State Leadership Conference, Psychology and Communities: Advancing Health, Building Resilience and Changing Behavior, Russ proffered: "Educating policy makers about the value of psychological services is also a must, despite being a process that often takes a very long time…. The one thing we should do is assure that our skills as psychologists are honed to facilitate behavior change in those whose unhealthy behaviors are taking a toll…. The bigger question for today is how do we spread the word that health care reform is really about behavior 'reform'? How do we persuade policy makers, that the solution to at least some of their biggest problems is right at our finger tips?" Perhaps, as Russ suggested over a decade ago, it will be by educating society and working closely with impacted communities that we will eventually reach that desired "Tipping Point" envisioned by Malcolm Gladwell at our APA Annual Convention just two years later. Aloha,

Pat DeLeon, former APA President – Division 18 – September, 2018


Sent from my iPhone

ALOHA - Division 18 September column

MEANINGFUL STEPS, STEADY PROGRESS

            The weekend following APA’s 126^th Annual Convention in San Francisco, I had the opportunity to attend Beth Rom-Rymer’s Fifth Biannual Prescriptive Authority (RxP) Networking dinner in the Windy City, where our 127^th Annual Convention will be held.  “‘You have a moment, a moment in which you can have psychologists prescribing in Illinois.  Or, you can walk away and close the door.  The resources spent would be lost.  Another opportunity may come, but it is beyond what the eye can see.’”  On August 18, 2018, more than four years after those words were spoken, 115 psychologists, attorneys, hospital CEO’s, chiefs of psychiatry, and graduate and undergraduate students attended an RxP dinner networking event in my home.  APA CEO Arthur Evans; Pat; and internationally renowned trauma researcher, Stevan Hobfoll, were the keynote speakers.  Also speaking were the six psychologists who are currently doing their medical residency training, one of the three required elements for prescriptive authority licensure in Illinois.

            “In Illinois, two psychologists have now applied for a prescribing psychologist’s license.  Six psychologists are well-ensconced in their residency training (nine medical rotations, at 20 or 30 hours a week, over a period of no less than 14 months) in four of the more than 50 major medical centers in Illinois.  Over 40 practicing psychologists are pursuing their Master’s degree in Clinical Psychopharmacology or studying for their capstone exam, the Psychopharmacological Exam for Psychologists (PEP-2).  Ten graduate students are pursuing their Master’s degrees in Clinical Psychopharmacology while pursuing their doctorate degrees in psychology.  And, 75 undergraduate students at The University of Illinois, Champaign-Urbana, have declared a ‘concentration’ in the ‘pre-emerging psychology’ undergraduate curriculum, which consists of the traditional required undergraduate psychology courses and the seven basic non-psychology science courses, required in the 2014 Prescriptive Authority Illinois statute.

            “The Chicago School of Professional Psychology is currently the only institution in the country to offer graduate students the opportunity to take a joint degree in Clinical Psychopharmacology, while studying for the doctorate in Psychology.  The students, who are taking the Master’s of Science degrees at The Chicago School, are pursuing their doctorate degrees at that school as well as at other professional psychology schools and Universities in Illinois.  The Chicago School can offer this training because Illinois is unique, among all of the prescribing states, in that its prescribing statute allows graduate/predoctoral students to take the joint degree.   We have built our model upon the foundation provided by my visionary colleague, Lenora Walker, at Nova Southeastern University, several years ago.

            “Pursuant to an August 1996 APA Council of Representatives decision, psychologists have been required to have graduated from a doctoral program in psychology; hold a current state license as a psychologist; practice as a ‘health services provider,’ as defined by state law and/or APA; in order to begin their training toward a prescribing psychologist license.  The APA Designation Committee for Postdoctoral Education and Training Programs in Psychopharmacology for Prescriptive Authority has made a recommendation in its 2018 report to Council, that APA offer approval to Psychopharmacology training programs that include predoctoral graduate students.  The APA Council will review this Report in 2019.  Graduate students in Illinois are thrilled about the opportunity to broaden their course of study, while in graduate school, just as students have benefited from doing joint degrees in medicine, law, business, and nursing, throughout the last half-century.

            “Four years ago, we were balancing on the precipice.  Today, licensed clinical psychologists, as well as psychology undergraduate and graduate students, are undergoing rigorous training to become prescribing psychologists.  Having made the decision to go forward, Illinois psychologists are making history by creating significant changes in the delivery of mental healthcare services in Illinois” (Beth Rom-Rymer, APA Board of Directors).

Substantive change always takes time.  Back in 1992, the APA Task Force on Prescriptive Authority, chaired by Mick Smyer, proffered: “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 (and has) the potential to dramatically improve patient care and make important new advances in treatment.”

            While listening to National Public Radio (NPR) the weekend after Beth’s exciting soirée, I heard a familiar voice addressing the complex behavioral health issues surrounding adolescent gaming.  It was none other than David Greenfield, who had attended Beth’s event, describing his Center for Internet and Technology Addiction perspective.  “I recently had the pleasure of being interviewed on my favorite media forum – NPR.  Perhaps this may reveal something of my sociopolitical leanings, but that aside, I really enjoy the depth of being able to explore the issues at hand.  This was my most recent of about a half-dozen NPR interviews on Internet, Video Game, and Technology addiction.  This show focused on the oft-debated discussion of the diagnostic validity of this newly-minted psychological diagnosis by the World Health Organization (WHO) for mid-year inclusion in the ICD-11 as ‘Video Gaming Disorder.’  The show’s focus was on whether or not there is, indeed, such a disorder at all, and its scientific basis or lack thereof.

            “My opinion has always been informed from the perspective of a practicing clinician primarily.  Although I have done research and written quite a bit on the subject, my perspective is that I didn’t invent the disorder, rather the disorder came to me – patients suffering from issues related to their video game use have been coming to me for treatment over the last 20 years (long before DSM’s provisional status and the recent WHO inclusion).  As psychologists we are ethically responsible to help alleviate human pain, suffering, and dysfunction.  And yes, while it is true that the jury may still be out on the exact nature, definition, and treatment of this disorder, the fact remains that there is an impactful set of symptoms that many people are experiencing.  While it is important as scientists to get our diagnostic definitions and nosology correct, it is also both unethical and impractical to ask our patients to leave our offices and return only after we have worked out all the diagnostic kinks.  Frankly, I am not sure I even care what we call it.  I just know I have been treating it long before we had a diagnosis on the horizon, and although I am glad we are researching this topic more thoroughly, I still need to care for those patients suffering now.”

            David’s presentation brought back fond memories of another APA visionary, former Practice Directorate Executive Director Russ Newman.  In March, 2006 at the annual State Leadership Conference, Psychology and Communities: Advancing Health, Building Resilience and Changing Behavior, Russ proffered: “Educating policy makers about the value of psychological services is also a must, despite being a process that often takes a very long time….  The one thing we should do is assure that our skills as psychologists are honed to facilitate behavior change in those whose unhealthy behaviors are taking a toll….  The bigger question for today is how do we spread the word that health care reform is really about behavior ‘reform’?  How do we persuade policy makers, that the solution to at least some of their biggest problems is right at our finger tips?”  Perhaps, as Russ suggested over a decade ago, it will be by educating society and working closely with impacted communities that we will eventually reach that desired “Tipping Point” envisioned by Malcolm Gladwell at our APA Annual Convention just two years later.  Aloha,

Pat DeLeon, former APA President – Division 18 – September, 2018