WE’VE COME A LONG WAY FROM THE DAYS….

Forever Expanding the Boundaries of What is Possible: As Steve Ragusea emphasized over a decade ago, those colleagues within the Department of Defense (DOD) who were willing to take a chance on becoming the pioneering prescribing psychologists (RxP) effectively demonstrated for the profession that they could be trained to provide high quality, cost-effective psychopharmacological care. Today's advocates should appreciate the lasting contributions of retired military officers U.S. Navy Morgan Sammons and John Sexton; U.S. Army Anita Brown and Debra Dunivin; and U.S. Air Force Elaine Foster and Jim Meredith. Without their vision and dedication, we would never have come so far.

APA Board of Directors member Beth Rom-Rymer: "In 1996, APA Council was asked to pass a Resolution that would give the APA imprimatur to a new specialization: prescribing psychologists. After much discussion, Council voted to authorize the training of prescribing psychologists, but only after attaining licensure as clinical psychologists. Any pre-licensure in Clinical Psychopharmacology would be invalidated. The Council members' concern was that prescribing psychologists might dilute their identities as clinical psychologists if they were to train in Clinical Psychopharmacology while pursuing their doctorates in clinical psychology.

"Excited about the APA resolution, NOVA Southeastern University, from 2001-2009, offered training in Clinical Psychopharmacology at the graduate level as well as at the post-doctoral level. While APA had not approved the training at the graduate level, NOVA professors, particularly Eugene Shapiro, firmly believed that graduate students would benefit from doing their didactic training while still in graduate school. Therefore, several professors, including William (Joe) Burns and Lenora Walker, conducted outcome research on their students. They, indeed, found that the graduate students did at least as well on the course exams as the older, more experienced clinicians and identity as a 'psychologist' was not compromised.

"Bob Ax, Bob Resnick, and I, along with Gene, Lenora and Joe, and other NOVA faculty were early advocates for prescribing psychology trainees having access to the didactic training at the pre-doctoral, graduate level. It made sense to us that graduate students would appreciate the opportunity to begin their training in Clinical Psychopharmacology while still in school! It also made sense that while older clinicians could certainly go back to school to earn their Master's (MS) degree, the hardship of returning to school, and putting aside their full-time career and family responsibilities could be avoided. Given some of our experience in the training of prescribing psychology trainees, the psychologist's 'identity' was not threatened.

"In 2011, as I was preparing, with my team at the Illinois Psychological Association, to organize psychologists in the pursuit of RxP legislation in our state, I arranged a meeting for advocates, from around the country, to talk with Katherine Nordal, then-Executive Director of the APA Practice Directorate. The salient issue on the agenda was pre-doctoral training in Clinical Psychopharmacology. Katherine's brilliant suggestion was that we do the Master of Science degree in Clinical Psychopharmacology, and the doctorate in Clinical Psychology, as 'joint degrees,' just as psychologists do joint degrees in law, public policy, nursing, or business.

"In our Illinois Prescriptive Authority legislation, we merely omitted the word 'postdoctoral' when we discussed the education and training of the prescribing psychologist. While legislators worried about the quality of the teaching and the clinical supervision and the breath of clinical training, there was never any concern that our didactic training in Clinical Psychopharmacology would be done simultaneously with the Psychology doctorate.

"When our Illinois legislation passed in 2014, we not only had requirements for the Master's degree in Clinical Psychopharmacology, but we also had seven undergraduate physical science course requirements and a series of nine rotations in various medical specialties, over a period of not less than 14 months, at no less than 20 hours a week. At the same time, our Illinois law was unique, among other prescribing states, in that it allowed graduate students to do their Master's degrees in Clinical Psychopharmacology while still in graduate school.

"Our next hurdle was to persuade a university to offer training to graduate students in Clinical Psychopharmacology, even though the APA would not approve or 'designate' such a program. I will be forever grateful to The Chicago School of Professional Psychology, in Chicago, that had the courage to provide this graduate training. Its Director, Gerardo Rodruiguez-Menendez, is a graduate of that first NOVA Clinical Psychopharmacology training class. Never wanting to leave any stone unturned, we continued to work with APA for a 'Designation' criteria revision that would include pre-doctoral Clinical Psychopharmacology training.

"When the APA Designation criteria were scheduled to be reviewed, in its five year cycle, in 2017, the issue of doing the training at the graduate level was a high priority to be discussed. Elaine Foster, Marlin Hoover, Alan Lincoln, and Elaine LeVine, all prescribing psychologists and preeminent trainers of prescribing psychologists, were on the Task Force, and were in favor of this change. Accordingly, it is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists. One of the salient curriculum revisions was that the didactic portion of the training could be taken at the pre-doctoral graduate level.

"Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses. They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology, as graduate students, as are 10 current graduate students. Change can cause anxiety. Sometimes, it feels easier to stay in the same lane. But, just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities."

Futuristic Public Sector Training: The Uniformed Services University (USU) is the nation's only Federal graduate and undergraduate degree-granting health sciences university. It provides wonderful opportunities for cutting-edge training experiences. "Faculty at the USU Daniel K. Inouye Graduate School of Nursing (GSN) introduced me to the simulated training concept as a Psychiatric Mental Health Nurse Practitioner student. The idea of having actors as patients with curated medical histories while faculty and peers monitor my interaction sounded unnatural and outright nerve-racking. As I waited for my first encounter, I was fraught with anxious anticipation. However, once I greeted my live patient, the familiarity of the nurse-patient relationship grounded me, and I was able to focus on the task at hand. Three semesters in and counting, the Val G. Hemming Simulated Center's standardized patients continue to build my provider skills. As an added feature, the video capture allows me to playback cringe-worthy missteps at home. While at times unbearable to watch, it provides invaluable insight into areas I need to improve. Without a doubt, the controlled yet realistic simulations help guide me on the road to becoming a confident, compassionate and competent mental health provider" [Geraldine Waters, MAJ, ARMY, PMHNP Class of 2021].

"Similar to the PMHNP program, the Clinical Psychology program at USU uses the SIM Center and standardized patients (SPs) for formative learning and summative evaluation experiences. In assessment, cognitive and behavioral therapy, and brief dynamic courses, students practice assessment and intervention skills with the SPs. At the end of their third year, these students participate in an Objective Structured Clinical Examination (OSCE), which uses stations at the SIM Center to evaluate clinical skills in a systematic manner with a range of presenting problems as portrayed by the SPs. Faculty and the SPs evaluate the skills and provide feedback to students using competency evaluations. The opportunity to provide these experiences in an environment where errors do not affect the functioning of patients seeking care, provide a unique opportunity for student learning" [Jeff Goodie, CAPT. USPHS].

"When I visited the VA clinic in American Samoa, I was startled to learn they had been actively trying to fill a Psychiatric Mental Health Nurse Practitioner (PMHNP) position for four years without a single application. Ultimately, they found a PMHNP in Hawaii who was willing to telecommute. While it was disheartening to learn that the patients of American Samoa face such a shortage of on-island providers, I was encouraged to see telehealth technology fully functioning within the VA clinic. Their pharmacy as well as this new psychiatric role are both supported by off-island staff in Hawaii.

"This reminded me of the telehealth training I received at the Sim Center; the first time I experienced remote patient care firsthand. Although my 'patient' was just down the hall, the scenario was thoroughly planned so it seemed he was at home in a location far from my 'clinic.' This type of patient care is invaluable in the sense of access to services, but it adds an extra layer of communication challenges that are best overcome through training and practice. When considering how USU students could be better prepared to interact with patients in American Samoa, why not combine telehealth training with cultural competency? I recently learned of 'The American Samoa Society of Washington, DC,' whose mission is to 'foster enduring relationships with the common goal of sharing our Samoan values, culture, tradition, and native tongue.' Perhaps they would embrace portraying Samoan 'patients' during telehealth training" [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].

Unchartered Waters: We have come to appreciate that a number of colleagues currently engaged in public service are quite interested in also providing clinical services, perhaps on a part-time basis, through private practice. Jeff Barnett and Jeff Zimmerman recently published If You Build It They Will Come and Other Myths of Private Practice in the Mental Health Professions. Their enumerated twenty-nine myths to contemplate are practical, comprehensive, and even, at times, humorous. For example, "I am the boss. Who needs policies and procedures?" And, "If I treat my staff well, they will take care of me and look out for my best interests." At the annual APA convention, Rod Baker and I have been hosting a Division 18 symposium on Meaningful Retirement for an increasingly engaged audience. Many are contemplating continuing to be engaged in psychology; however, at a reduced level and undoubtedly in a new locus. Yet, few have any practical experience with the administrative complexities and legal/ethical aspects they will undoubtedly encounter. Former APA President Bob Resnick commented on their book: "This book anticipates virtually all the questions about going into independent practice. It will reduce your anxiety and provide reasoned guidance…." "But we still have a way to go" (Justice Ruth Bader Ginsburg). Aloha,

Pat DeLeon, former APA President – Division 18 – March, 2019



Sent from my iPhone

Division 18 column -- ALOHA

“WE’VE COME A LONG WAY FROM THE DAYS….”

            Forever Expanding the Boundaries of What is Possible:  As Steve Ragusea emphasized over a decade ago, those colleagues within the Department of Defense (DOD) who were willing to take a chance on becoming the pioneering prescribing psychologists (RxP) effectively demonstrated for the profession that they could be trained to provide high quality, cost-effective psychopharmacological care.  Today’s advocates should appreciate the lasting contributions of retired military officers U.S. Navy Morgan Sammons and John Sexton; U.S. Army Anita Brown and Debra Dunivin; and U.S. Air Force Elaine Foster and Jim Meredith.  Without their vision and dedication, we would never have come so far.

            APA Board of Directors member Beth Rom-Rymer:  “In 1996, APA Council was asked to pass a Resolution that would give the APA imprimatur to a new specialization: prescribing psychologists.  After much discussion, Council voted to authorize the training of prescribing psychologists, but only after attaining licensure as clinical psychologists.  Any pre-licensure in Clinical Psychopharmacology would be invalidated.  The Council members’ concern was that prescribing psychologists might dilute their identities as clinical psychologists if they were to train in Clinical Psychopharmacology while pursuing their doctorates in clinical psychology.

“Excited about the APA resolution, NOVA Southeastern University, from 2001-2009, offered training in Clinical Psychopharmacology at the graduate level as well as at the post-doctoral level.  While APA had not approved the training at the graduate level, NOVA professors, particularly Eugene Shapiro, firmly believed that graduate students would benefit from doing their didactic training while still in graduate school.  Therefore, several professors, including William (Joe) Burns and Lenora Walker, conducted outcome research on their students.  They, indeed, found that the graduate students did at least as well on the course exams as the older, more experienced clinicians and identity as a ‘psychologist’ was not compromised.

“Bob Ax, Bob Resnick, and I, along with Gene, Lenora and Joe, and other NOVA faculty were early advocates for prescribing psychology trainees having access to the didactic training at the pre-doctoral, graduate level.  It made sense to us that graduate students would appreciate the opportunity to begin their training in Clinical Psychopharmacology while still in school!  It also made sense that while older clinicians could certainly go back to school to earn their Master’s (MS) degree, the hardship of returning to school, and putting aside their full-time career and family responsibilities could be avoided.  Given some of our experience in the training of prescribing psychology trainees, the psychologist’s ‘identity’ was not threatened.

“In 2011, as I was preparing, with my team at the Illinois Psychological Association, to organize psychologists in the pursuit of RxP legislation in our state, I arranged a meeting for advocates, from around the country, to talk with Katherine Nordal, then-Executive Director of the APA Practice Directorate.  The salient issue on the agenda was pre-doctoral training in Clinical Psychopharmacology.  Katherine’s brilliant suggestion was that we do the Master of Science degree in Clinical Psychopharmacology, and the doctorate in Clinical Psychology, as ‘joint degrees,’ just as psychologists do joint degrees in law, public policy, nursing, or business.

“In our Illinois Prescriptive Authority legislation, we merely omitted the word ‘postdoctoral’ when we discussed the education and training of the prescribing psychologist.  While legislators worried about the quality of the teaching and the clinical supervision and the breath of clinical training, there was never any concern that our didactic training in Clinical Psychopharmacology would be done simultaneously with the Psychology doctorate.

“When our Illinois legislation passed in 2014, we not only had requirements for the Master’s degree in Clinical Psychopharmacology, but we also had seven undergraduate physical science course requirements and a series of nine rotations in various medical specialties, over a period of not less than 14 months, at no less than 20 hours a week.  At the same time, our Illinois law was unique, among other prescribing states, in that it allowed graduate students to do their Master’s degrees in Clinical Psychopharmacology while still in graduate school.

“Our next hurdle was to persuade a university to offer training to graduate students in Clinical Psychopharmacology, even though the APA would not approve or ‘designate’ such a program.  I will be forever grateful to The Chicago School of Professional Psychology, in Chicago, that had the courage to provide this graduate training.  Its Director, Gerardo Rodruiguez-Menendez, is a graduate of that first NOVA Clinical Psychopharmacology training class.  Never wanting to leave any stone unturned, we continued to work with APA for a ‘Designation’ criteria revision that would include pre-doctoral Clinical Psychopharmacology training.

“When the APA Designation criteria were scheduled to be reviewed, in its five year cycle, in 2017, the issue of doing the training at the graduate level was a high priority to be discussed.  Elaine Foster, Marlin Hoover, Alan Lincoln, and Elaine LeVine, all prescribing psychologists and preeminent trainers of prescribing psychologists, were on the Task Force, and were in favor of this change.  Accordingly, it is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists.  One of the salient curriculum revisions was that the didactic portion of the training could be taken at the pre-doctoral graduate level.

“Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses.  They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology, as graduate students, as are 10 current graduate students.  Change can cause anxiety.  Sometimes, it feels easier to stay in the same lane.  But, just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities.”

            Futuristic Public Sector Training:  The Uniformed Services University (USU) is the nation’s only Federal graduate and undergraduate degree-granting health sciences university.  It provides wonderful opportunities for cutting-edge training experiences.  “Faculty at the USU Daniel K. Inouye Graduate School of Nursing (GSN) introduced me to the simulated training concept as a Psychiatric Mental Health Nurse Practitioner student.  The idea of having actors as patients with curated medical histories while faculty and peers monitor my interaction sounded unnatural and outright nerve-racking.  As I waited for my first encounter, I was fraught with anxious anticipation.  However, once I greeted my live patient, the familiarity of the nurse-patient relationship grounded me, and I was able to focus on the task at hand.  Three semesters in and counting, the Val G. Hemming Simulated Center’s standardized patients continue to build my provider skills.  As an added feature, the video capture allows me to playback cringe-worthy missteps at home.  While at times unbearable to watch, it provides invaluable insight into areas I need to improve.  Without a doubt, the controlled yet realistic simulations help guide me on the road to becoming a confident, compassionate and competent mental health provider” [Geraldine Waters, MAJ, ARMY, PMHNP Class of 2021].

            “Similar to the PMHNP program, the Clinical Psychology program at USU uses the SIM Center and standardized patients (SPs) for formative learning and summative evaluation experiences.  In assessment, cognitive and behavioral therapy, and brief dynamic courses, students practice assessment and intervention skills with the SPs.  At the end of their third year, these students participate in an Objective Structured Clinical Examination (OSCE), which uses stations at the SIM Center to evaluate clinical skills in a systematic manner with a range of presenting problems as portrayed by the SPs.  Faculty and the SPs evaluate the skills and provide feedback to students using competency evaluations.  The opportunity to provide these experiences in an environment where errors do not affect the functioning of patients seeking care, provide a unique opportunity for student learning” [Jeff Goodie, CAPT. USPHS].

            “When I visited the VA clinic in American Samoa, I was startled to learn they had been actively trying to fill a Psychiatric Mental Health Nurse Practitioner (PMHNP) position for four years without a single application.  Ultimately, they found a PMHNP in Hawaii who was willing to telecommute.  While it was disheartening to learn that the patients of American Samoa face such a shortage of on-island providers, I was encouraged to see telehealth technology fully functioning within the VA clinic.  Their pharmacy as well as this new psychiatric role are both supported by off-island staff in Hawaii.

“This reminded me of the telehealth training I received at the Sim Center; the first time I experienced remote patient care firsthand.  Although my ‘patient’ was just down the hall, the scenario was thoroughly planned so it seemed he was at home in a location far from my ‘clinic.’  This type of patient care is invaluable in the sense of access to services, but it adds an extra layer of communication challenges that are best overcome through training and practice.  When considering how USU students could be better prepared to interact with patients in American Samoa, why not combine telehealth training with cultural competency?  I recently learned of ‘The American Samoa Society of Washington, DC,’ whose mission is to ‘foster enduring relationships with the common goal of sharing our Samoan values, culture, tradition, and native tongue.’  Perhaps they would embrace portraying Samoan ‘patients’ during telehealth training” [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].

            Unchartered Waters:  We have come to appreciate that a number of colleagues currently engaged in public service are quite interested in also providing clinical services, perhaps on a part-time basis, through private practice.  Jeff Barnett and Jeff Zimmerman recently published If You Build It They Will Come and Other Myths of Private Practice in the Mental Health Professions.  Their enumerated twenty-nine myths to contemplate are practical, comprehensive, and even, at times, humorous.  For example, “I am the boss.  Who needs policies and procedures?”  And, “If I treat my staff well, they will take care of me and look out for my best interests.”  At the annual APA convention, Rod Baker and I have been hosting a Division 18 symposium on Meaningful Retirement for an increasingly engaged audience.  Many are contemplating continuing to be engaged in psychology; however, at a reduced level and undoubtedly in a new locus.  Yet, few have any practical experience with the administrative complexities and legal/ethical aspects they will undoubtedly encounter.  Former APA President Bob Resnick commented on their book: “This book anticipates virtually all the questions about going into independent practice.  It will reduce your anxiety and provide reasoned guidance….”  “But we still have a way to go” (Justice Ruth Bader Ginsburg).  Aloha,

Pat DeLeon, former APA President – Division 18 – March, 2019

MEMORIES ARE MADE FROM THIS

Our state psychological associations have always been the key to advancing professional practice. Several of our executive directors, such as Ohio's Michael Ranney who has served since June of 1997, have been with psychology from the earliest years of Practice Leadership Conference, which in my judgment is the highlight of the year. Another visionary stalwart, Sally Cameron, recently retired after 38 years of serving the North Carolina Psychological Association (NCPA). Sally became the first NCPA Executive Director in January of 1981.

"It has been the honor of my career to serve as Executive Director. I am excited today as I was in 1981 about your profession and the contributions you make to the state and to society. As NCPA celebrated its 70th anniversary in 2018, it was a time for reflection. Together we accomplished a great deal, and there is still much more to be done. As I look back over my 38 years, how things have changed. From an office in my home to a rental space; from file cards to a computer with a database; from that rental space to our wonderful permanent headquarters in Raleigh; from being the only staff person to a staff of four plus our long time Director of Professional Affairs and our lobbyist; and much more.

"NCPA is an incredible organization. Psychology has been so fortunate to have so many members over my 38 years who have given an unbelievable amount of their time, talent and treasure to their professional organization. Working with each one has been a privilege and a pleasure. Traveling throughout the state to meet many psychologists at local gatherings and continuing education activities was such a joyous part of my role.

"I am very grateful to the support from APA, and particularly the Practice Organization; for state psychological associations; and for CESPPA, the professional organization for executive directors of state, provincial and territorial associations. The decision to retire was not easy – especially when you love what you do. But it was time – a time to spend even more time with my wonderful and ever so supportive husband Jim, more time with friends and family, and to do the psychologically healthy thing – rest and relax. I will miss NCPA but I know that with the commitment of the leaders and members, NCPA and psychology will continue to thrive for many years to come. Thanks for the memories" (Sally Cameron).

"Sally is an icon in the world of Executive Directors for psychological associations. Besides being a wonderful person she was a wonderful mentor to many including me during my time with both NCPA and APA. Psychology, and I, owe a debt of significant gratitude to Sally" (Tony Puente, former APA President).

Don't Forget a Small Moonbeam: APA Board of Directors member Beth Rom-Rymer: "It is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists. One of the salient curriculum revisions was that the didactic portion of the training could be taken at the predoctoral graduate level. Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses. They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology as graduate students. Just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities." Aloha, [Dean Martin].

Pat DeLeon, former APA President – Division 31 – March, 2019

ALOHA

“MEMORIES ARE MADE FROM THIS”

            Our state psychological associations have always been the key to advancing professional practice.  Several of our executive directors, such as Ohio’s Michael Ranney who has served since June of 1997, have been with psychology from the earliest years of Practice Leadership Conference, which in my judgment is the highlight of the year.  Another visionary stalwart, Sally Cameron, recently retired after 38 years of serving the North Carolina Psychological Association (NCPA).  Sally became the first NCPA Executive Director in January of 1981.

“It has been the honor of my career to serve as Executive Director.  I am excited today as I was in 1981 about your profession and the contributions you make to the state and to society.  As NCPA celebrated its 70^th anniversary in 2018, it was a time for reflection.  Together we accomplished a great deal, and there is still much more to be done.  As I look back over my 38 years, how things have changed.  From an office in my home to a rental space; from file cards to a computer with a database; from that rental space to our wonderful permanent headquarters in Raleigh; from being the only staff person to a staff of four plus our long time Director of Professional Affairs and our lobbyist; and much more.

            “NCPA is an incredible organization.  Psychology has been so fortunate to have so many members over my 38 years who have given an unbelievable amount of their time, talent and treasure to their professional organization.  Working with each one has been a privilege and a pleasure.  Traveling throughout the state to meet many psychologists at local gatherings and continuing education activities was such a joyous part of my role.

            “I am very grateful to the support from APA, and particularly the Practice Organization; for state psychological associations; and for CESPPA, the professional organization for executive directors of state, provincial and territorial associations.  The decision to retire was not easy – especially when you love what you do.  But it was time – a time to spend even more time with my wonderful and ever so supportive husband Jim, more time with friends and family, and to do the psychologically healthy thing – rest and relax.  I will miss NCPA but I know that with the commitment of the leaders and members, NCPA and psychology will continue to thrive for many years to come.  Thanks for the memories” (Sally Cameron).

            “Sally is an icon in the world of Executive Directors for psychological associations.  Besides being a wonderful person she was a wonderful mentor to many including me during my time with both NCPA and APA.  Psychology, and I, owe a debt of significant gratitude to Sally” (Tony Puente, former APA President).

            Don’t Forget a Small Moonbeam:  APA Board of Directors member Beth Rom-Rymer:  “It is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists.  One of the salient curriculum revisions was that the didactic portion of the training could be taken at the predoctoral graduate level.  Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses.  They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology as graduate students.  Just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities.”  Aloha, [Dean Martin].

Pat DeLeon, former APA President – Division 31 – March, 2019