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
