The Modern Era of Technology: Back on April 27, 2004, President George W. Bush highlighted the importance for the nation of our health care system embracing the exciting potential of utilizing the advances in the communications and technology fields to provide the highest quality, cutting-edge care to our citizenry. "Today we're going to talk about (how) to make sure America is innovative and is a leader in the world, and that is how to make sure our health care system works better. And there are some fantastic ideas as to how to do that. The way I like to kind of try to describe health care is, on the research side, we're the best…. Except when you think about the provider's side, we're kind of still in the buggy era…. There's a lot of talk about productivity gains in our society, and that's because companies and industries have properly used information technology. If properly used, it is an industry-changer for the good. It enables there to be a better cost structure and better quality care delivered, in this case in the health field. And, yet the health care industry hasn't touched it, except for certain areas. And one area that has is the Veterans Administration…. And one of the reasons the Veterans Administration is doing so well in changing, kind of, behavior… is because of our Secretary, a Vietnam Vet, a really decent guy, and who is doing a fabulous job, Tony Principi." Senior VA psychologists will recall that Secretary Principi attended the VA Psychology Leadership Conference, sponsored now by APA, Division 18, and AVAPL, during my APA Presidency.
Webinars: Ray Folen, Executive Director of the Hawaii Psychological Association (HPA): "In the mid-90's psychologists at Tripler Army Medical Center were providing counseling and psychotherapy using inexpensive videophones that – by today's standards – offered unimaginably low bandwidth. The video was often slow and pixelated, but it was sufficient – if barely so – to deliver needed services to those located in distant parts of the world. These early pioneering efforts demonstrated the utility and efficacy of this communications medium. Since then, of course, access to high bandwidth connectivity has increased tremendously, resulting in broad coverage and improved quality. The DOD and VA now embrace telehealth and, in particular, the use of behavioral telehealth.
"Videoconferencing for training and educational purposes has followed an evolutionary path similar to behavioral telehealth services. Compared to behavioral telehealth, though, the videoconference centers of the 90's had greater bandwidth (still pathetically low in today's terms). These centers were rare to find and required significant amounts of money, time and effort to operate. Videoconference sessions were highly complex events, typically requiring a dedicated videoconference room with $50K of equipment, full-time technical staff and extensive pre-session preparation. Despite all this effort, conference calls failed more often than not due to a myriad of technical problems: frozen screens, lost audio, lost connections, etc. As a result, these rooms were dark and unoccupied 95% of the time – it was simply too much trouble.
"The extraordinary changes in technology and bandwidth since that time have made videoconferencing available to just about anyone with a computer or smart device. Recently, HPA completed what may be our 100th videoconference session – an all-day in-person workshop that was simultaneously broadcast via the web to HPA members who attended the event from the comfort of their office or home. To date, 98% of our videoconference webinar workshops, presentations and meetings have been problem-free. They require a computer, a separate microphone and camera, and decent Wi-Fi connectivity. If Wi-Fi is not available, a cell phone with a 'hot spot' has provided an adequate Wi-Fi connection, as webinar platforms like 'Zoom' are very forgiving of variations in bandwidth and connectivity; audio and video quality has consistently been good.
"HPA now has highly-regarded researchers and authors giving presentations to us from all over the world. Costs are very low, given that a presentation via webinar requires no travel time or travel expenses. Almost without exception, invitations to present have received a positive response. The webinar format has become extremely popular with our members, who are now receiving excellent training in a very convenient format at very low cost."
The National Academy of Medicine (NAM) of the National Academies of Sciences, Engineering and Medicine has developed an impressive series of webinars addressing a wide range of critical global topics. This June the Culture of Health (on which Hortensia de los Angeles Amaro, Velma McBride Murry, and I have the honor of serving) will be hosting Messaging to Advance Health Equity in Public Policy. Co-Director Ivory Clarke effectively keeps stressing to the committee the importance of the community voice – ensuring that communities are continuously brought to the table and their unique expertise elevated if policy makers want to succeed. "Health equity is crucial and health inequity is costly. Communities across the country are deploying action strategies to reduce health inequities." Value-based messaging has proven effective in creating common ground to advance necessary change [https://nam.edu/event/messaging-to-advance-health-equity-in-public-policy/].
Under the visionary leadership of Morgan Sammons, the National Register has initiated a series of cutting-edge Clinical Webinars for health service psychologists, including this May Psychopharmacology Training and Legislation Update. "Webinars have become a quite effective vehicle for educating and disseminating valuable information to far-flung communities of psychologists. Gery Rodriguez-Menendez, Chair of the Clinical Psychopharmacology Department at the Chicago School of Professional Psychology, and I are conducting a webinar during which we will discuss the Illinois path to RxP legislative success and name the critical factors that any state could use to achieve RxP success. We will also be discussing the Illinois model of training for the prescribing psychologist that reflects our statutory requirements.
"The Chicago School of Professional Psychology is the only School, nationally, whose faculty are training psychology students, who have chosen to become prescribing psychologists, at the predoctoral level. Pursuant to the February, 2019 decision by the APA Council of Representatives to support the predoctoral training in Clinical Psychopharmacology, we expect that schools, nationwide, will begin to train predoctoral psychology students in Clinical Psychopharmacology, following our lead and that of NOVA Southeastern University, whose faculty trained predoctoral psychology students in the early 2000's.
"Every day, I receive calls from practicing psychologists. They have decided to begin their training to become prescribing psychologists because of the dire shortages of psychiatrists and of other healthcare professionals who have competence in diagnosing mental illness and prescribing psychotropic medications. A 2015 study by Princeton University researchers found that when advanced practice nurses were granted independent prescriptive authority in their states, the suicide rate, in those states, plummeted by 12%. I believe that we will see similar statistics in the states in which we have independently prescribing psychologists" (Beth Rom-Rymer, APA Board of Directors).
Licensure Mobility: One of the most significant consequences of the growing impact of technology on the health care field is the critical importance of licensure mobility for practitioners. "PSYPACT is operational! The Psychology Interjurisdictional Compact (PSYPACT) is an interstate compact designed to facilitate the practice of tele-psychology and the temporary in-person, face-to-face practice of psychology across state boundaries. PSYPACT allows psychologists to provide electronic psychological services from their home compact state to a patient in a distant compact state without having to be licensed in the distant state. It also allows psychologists to temporarily physically go into another compact state to provide face-to-face psychological services without having to be also licensed in that distant state. Legislative action by states is needed to adopt PSYPACT into law in their state. PSYPACT became operational once seven states adopted it. Now the PSYPACT Commission will be set up to develop the bylaws and oversee PSYPACT. This commission will be made up of one delegate from each compact state.
"As of May 1st 2019, PSYPACT is alive! The following states have adopted the necessary legislation: Arizona, Utah, Nevada, Colorado, Missouri, Nebraska, Georgia, Oklahoma, and Illinois (effective January 1st 2020). There is also active legislation in Rhode Island, New Hampshire, North Carolina, Texas, the District of Columbia, and Pennsylvania. Psychologists in these states are urged to contact their own legislators to support PSYPACT. For psychologists in compact states who want to provide interjurisdictional tele-psychology services to patients in other compact states, they will have to apply for an E.Passport and for those who want to temporarily provide in person, face-to-face services in other compact states, they will have to apply for an Interjurisdictional Practice Certificate (IPC)" (Alex Siegel, asiegel@asppb.org)." Our personal congratulations to Steve DeMers, former ASPPB Executive Director; Gerald O'Brien, President); and Mariann Burnetti-Atwell, CEO for their vision and persistence in successfully implementing this very important and timely APA Council Policy. "Make me warm all over" (Don Ho). Aloha,
Pat DeLeon, former APA President – Division 42 – May, 2019
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