IF A FREE SOCIETY CANNOT HELP THE MANY WHO ARE POOR

   Visionary Leaders:  Having the opportunity to spend time with the psychology and advanced practice nursing graduate students at the Uniformed Services University (USU) reinforces my appreciation for their passionate interest in learning the most up-to-date clinical skills.  Reflecting upon the history and probable future of psychology's quest for prescriptive authority (RxP), Fernanda De Oliveira (1^st Lt, USAF) and 2017 APA President Tony Puente proffered that those setting standards for APA accredited internships should facilitate the development of regular interprofessional seminars specifically focusing upon the potential use of psychotropic medications (pros- and cons-) for the patient populations being served.  They further called for the establishment of specialty RxP post-doctoral experiences (e.g., with children or the elderly).

The APA Ad Hoc Task Force on Psychopharmacology was established by the Council of Representatives in 1990 and chaired by Michael Smyer, with Tony serving as a member.  They concluded: "(T)he contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment."  They proposed three levels of training for allpracticing psychologists.  The first was rudimentary understanding of the use and limitations of psychopharmacological intervention.  The second was a mid-level but more in depth understanding including specific application and interaction between psychoactive medicines and mental disorders; e.g., what types of medications might have best impact on what types of depression.  Finally, the third level is what today is called prescription authority which entails both classroom and didactic training.  Psychology's RxP journey began in the Department of Defense with Navy Commander John Sexton and then-Lt. Commander Morgan Sammons being the first graduates of the PDP in 1994.  We would be veryinterested in learning whether any members of the Division have participated in interprofessional RxP seminars as envisioned by the Task Force.  We would expect that nursing and pharmacy would be the most receptive to such collaboration.

When the APA Council began considering RxP in the 1990s, a conscious decision was made to conceptualize the development of this new clinical skill at the post-doctoral level.  Last year, after two decades, the decision was made to relook at the timing of the educational requirements.  One of our most visionary colleagues, Beth Rom-Rymer, who was absolutely critical in Illinois enacting their RxP legislation in 2014, recently hosted her fourth Chicago evening soiree for those committed to advancing the agenda.  Beth has long supported providing the necessary didactic knowledge as early as possible in one's training:

"We had our biggest crowd, yet, for our Fourth Biannual Prescriptive Authority Networking Dinner, at my home, with over 100 people.  We had two distinguished keynote speakers: Arthur Evans, our APA CEO, and Danny Carlat, the first psychiatrist, of whom I'm aware, to publicly support RxP for psychologists.  Danny began to speak out, in our favor, in the late 1990's.  Arthur talked about the importance of strengthening the voice of APA: advocating for the science underlying our psychological principles; increasing opportunities for psychologists in integrated care; advocating for RxP for appropriately trained psychologists; advocating for psychologists in their relationships with managed care; advocating for those individuals in our society who do not have a voice but profoundly suffer from societal injustice.

"In 2010, Danny had written a blog, entitled, Psychologists prescribing is the best thing that can happen to psychiatry.  In part, he said: 'Psychiatry has boxed itself into a tiny corner of medicine called 'Psychopharmacology.'  It's a silly way to practice our craft, because the essence of what we do is to understand the mind and to help people live better lives.  Drugs are effective but only one of the tools available to us, and we have largely ceded psychotherapy to psychologists and social workers.  The result is a fragmentation of care….  As the safety data gradually accrues, I predict that psychologists will attain prescriptive privileges in most states over the next 10-20 years.  We saw the same pattern in the 1970's with Nurse Practitioners – psychiatrists and other physicians engaged in bitter turf wars initially, arguing that they didn't have enough training, but large scale health services research studies eventually demonstrated that NPs operated competently and safely, and now they are accepted as independent practitioners in most states…."  Saturday night, Danny reaffirmed his commitment to the state by state pursuit of RxP.  Since we had representatives from the states of Iowa, Ohio, Connecticut, and Virginia, the prescribing psychology advocates will collaborate with him as they move forward.

"There was a significant diversity of community partners that was represented at the Networking Dinner.  No legislative initiative succeeds without the active support of the larger community.  I recognized the indefatigable efforts of a number of our local healthcare systems.  These outstanding and visionary leaders committed their time, their energy, and their expertise, to create a series of rotation experiences for prescribing psychology trainees that will continue into the foreseeable future.  As we neared the end of our prepared program, I asked all of the 12 Psychology graduate students to come to the front of the room and introduce themselves to the group.  Two of the student leaders talked about why they are choosing to take joint degrees in Clinical Psychopharmacology along with their doctoral degrees in Psychology.  Several Early Career Psychologists introduced themselves, explaining why they are taking the training to become Prescribing Psychologists.  The event lasted almost until midnight.  There was a strong feeling of accomplishment in how we have progressed in the implementation of our statute and enthusiasm for the prominent roles that prescribing psychologists will take in repairing a faltering mental health system.

American Samoa – Federal Responsibility:  Under the leadership of Dean Carol Romano, former Chief Nurse Officer for the U.S. Public Health Service, USU nursing graduate students have begun clinical placements in American Samoa.  Located in the South Pacific, midway between Hawaii and New Zealand, this site was chosen in 1872 as a coaling station for the U.S. Navy.  After the attack on Pearl Harbor on December 7, 1941, naval activity there increased significantly.  It is a U.S. territory, covering seven islands and atolls.  Its population approximates 55,500 with a land mass of 76.8 square miles, slightly more than Washington, DC.  It is noted for having the highest rate of military enlistment of any U.S. state or territory.  With an extreme shortage of health professionals health disparities are rampant.  "It cannot save the few who are rich" [President John F. Kennedy, 1961].  Aloha,

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

 

 

Sent from my iPhone

Div 19 column

IF A FREE SOCIETY CANNOT HELP THE MANY WHO ARE POOR,

            Visionary Leaders:  Having the opportunity to spend time with the psychology and advanced practice nursing graduate students at the Uniformed Services University (USU) reinforces my appreciation for their passionate interest in learning the most up-to-date clinical skills.  Reflecting upon the history and probable future of psychology’s quest for prescriptive authority (RxP), Fernanda De Oliveira (1^st Lt, USAF) and 2017 APA President Tony Puente proffered that those setting standards for APA accredited internships should facilitate the development of regular interprofessional seminars specifically focusing upon the potential use of psychotropic medications (pros- and cons-) for the patient populations being served.  They further called for the establishment of specialty RxP post-doctoral experiences (e.g., with children or the elderly).

The APA Ad Hoc Task Force on Psychopharmacology was established by the Council of Representatives in 1990 and chaired by Michael Smyer, with Tony serving as a member.  They concluded: “(T)he contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment.”  They proposed three levels of training for all practicing psychologists.  The first was rudimentary understanding of the use and limitations of psychopharmacological intervention.  The second was a mid-level but more in depth understanding including specific application and interaction between psychoactive medicines and mental disorders; e.g., what types of medications might have best impact on what types of depression.  Finally, the third level is what today is called prescription authority which entails both classroom and didactic training.  Psychology’s RxP journey began in the Department of Defense with Navy Commander John Sexton and then-Lt. Commander Morgan Sammons being the first graduates of the PDP in 1994.  We would be very interested in learning whether any members of the Division have participated in interprofessional RxP seminars as envisioned by the Task Force.  We would expect that nursing and pharmacy would be the most receptive to such collaboration.

When the APA Council began considering RxP in the 1990s, a conscious decision was made to conceptualize the development of this new clinical skill at the post-doctoral level.  Last year, after two decades, the decision was made to relook at the timing of the educational requirements.  One of our most visionary colleagues, Beth Rom-Rymer, who was absolutely critical in Illinois enacting their RxP legislation in 2014, recently hosted her fourth Chicago evening soiree for those committed to advancing the agenda.  Beth has long supported providing the necessary didactic knowledge as early as possible in one’s training:

“We had our biggest crowd, yet, for our Fourth Biannual Prescriptive Authority Networking Dinner, at my home, with over 100 people.  We had two distinguished keynote speakers: Arthur Evans, our APA CEO, and Danny Carlat, the first psychiatrist, of whom I’m aware, to publicly support RxP for psychologists.  Danny began to speak out, in our favor, in the late 1990’s.  Arthur talked about the importance of strengthening the voice of APA: advocating for the science underlying our psychological principles; increasing opportunities for psychologists in integrated care; advocating for RxP for appropriately trained psychologists; advocating for psychologists in their relationships with managed care; advocating for those individuals in our society who do not have a voice but profoundly suffer from societal injustice.

“In 2010, Danny had written a blog, entitled, Psychologists prescribing is the best thing that can happen to psychiatry.  In part, he said: ‘Psychiatry has boxed itself into a tiny corner of medicine called ‘Psychopharmacology.’  It’s a silly way to practice our craft, because the essence of what we do is to understand the mind and to help people live better lives.  Drugs are effective but only one of the tools available to us, and we have largely ceded psychotherapy to psychologists and social workers.  The result is a fragmentation of care….  As the safety data gradually accrues, I predict that psychologists will attain prescriptive privileges in most states over the next 10-20 years.  We saw the same pattern in the 1970’s with Nurse Practitioners – psychiatrists and other physicians engaged in bitter turf wars initially, arguing that they didn’t have enough training, but large scale health services research studies eventually demonstrated that NPs operated competently and safely, and now they are accepted as independent practitioners in most states….”  Saturday night, Danny reaffirmed his commitment to the state by state pursuit of RxP.  Since we had representatives from the states of Iowa, Ohio, Connecticut, and Virginia, the prescribing psychology advocates will collaborate with him as they move forward.

“There was a significant diversity of community partners that was represented at the Networking Dinner.  No legislative initiative succeeds without the active support of the larger community.  I recognized the indefatigable efforts of a number of our local healthcare systems.  These outstanding and visionary leaders committed their time, their energy, and their expertise, to create a series of rotation experiences for prescribing psychology trainees that will continue into the foreseeable future.  As we neared the end of our prepared program, I asked all of the 12 Psychology graduate students to come to the front of the room and introduce themselves to the group.  Two of the student leaders talked about why they are choosing to take joint degrees in Clinical Psychopharmacology along with their doctoral degrees in Psychology.  Several Early Career Psychologists introduced themselves, explaining why they are taking the training to become Prescribing Psychologists.  The event lasted almost until midnight.  There was a strong feeling of accomplishment in how we have progressed in the implementation of our statute and enthusiasm for the prominent roles that prescribing psychologists will take in repairing a faltering mental health system.

American Samoa – Federal Responsibility:  Under the leadership of Dean Carol Romano, former Chief Nurse Officer for the U.S. Public Health Service, USU nursing graduate students have begun clinical placements in American Samoa.  Located in the South Pacific, midway between Hawaii and New Zealand, this site was chosen in 1872 as a coaling station for the U.S. Navy.  After the attack on Pearl Harbor on December 7, 1941, naval activity there increased significantly.  It is a U.S. territory, covering seven islands and atolls.  Its population approximates 55,500 with a land mass of 76.8 square miles, slightly more than Washington, DC.  It is noted for having the highest rate of military enlistment of any U.S. state or territory.  With an extreme shortage of health professionals health disparities are rampant.  “It cannot save the few who are rich” [President John F. Kennedy, 1961].  Aloha,

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

 

 

NEVER DOUBT THAT A SMALL GROUP OF THOUGHTFUL, COMMITTED CITIZENS CAN CHANGE THE WORLD

 The very last event which APA President Tony Puente presided over was to personally present the Presidential Citation to former Division 29 President Ron Fox.  "On the closing of the American Psychological Association's 125^th anniversary, I, Antonio E. Puente, as President of our venerable society bestow upon Ronald E. Fox this APA Presidential citation on December 31, 2017.  From humble beginnings to being President of our great association, Ron Fox has been driven with a vision of making our world a better place through making the profession of psychology a central change agent.  His long and illustrious career has spanned several decades and various settings including as a clinician, a professor, and an advocate for the profession of psychology.  Starting early in his career, Dr. Fox stood firmly for ethnic-minorities, for women, and for the poor, when such advocacy was considered unimportant.

            "Within APA, he has held numerous governance positions from committee member to being President, and a trustee of the Insurance Trust.  Dr. Fox has been a pioneer in so many venues that it is impossible to list them all.  But here are some important illustrations: key in establishing the APA Practice Directorate, Division 29 (Psychotherapy), Division 55 (Psychopharmacology), and the Association of Psychology Postdoctoral and Internship Centers (APPIC).  He advocated in Ohio for the founding of one of the first Doctor of Psychology programs in the U.S.  Dr. Fox was instrumental in establishing one of the first psychology licensing boards in the U.S. (Ohio).  In addition, he is considered the 'grandfather' for prescription authority in psychology.

            "Ron Fox has been a calm, steady, and reasoned voice for all of psychology for almost half a century.  For his efforts, his resiliency, his vision, and the many results that have made the profession of psychology what it is today, on this last day of APA's 125^th anniversary, let it be known that Ronald E. Fox is presented this APA Presidential Citation."

            Prescriptive Authority (RxP):  From the very beginning, Ron Fox has been a visionary leader in psychology's quest for prescriptive authority (RxP).  Michael Schwarzchild was one of the first colleagues to respond to Ron's call.  Although the State of Connecticut was not initially successful, CPA President Anne Klee reports they have once again returned to this important policy agenda.  Former CPA President and RxP committee chair Barbara Bunk: "I am writing with surprising but good news re the RxP effort in Connecticut.  Our Department of Public Health (DPH) has recently informed CPA that our request for review of our scope of practice to include prescriptive authority for appropriately trained psychologists has been accepted.  DPH is now forming a Committee to review and evaluate the request, and to make subsequent recommendations to the Public Health Committee of the Connecticut General Assembly for the 2018 Legislative Session.  The Committee is comprised of the six healthcare organizations that submitted impact statements regarding our request; each organization gets two seats on the Committee, as do we (CPA).  Notably, the Connecticut Psychiatric Society did not appropriately submit, though the DPH Commissioner can indeed appoint additional Committee members if he so chooses – which he subsequently decided to do.

"The six organizations were CTAPRNS – Connecticut Advanced Practice Nurse Society; CCACP – Connecticut Council of Child and Adolescent Psychiatry; CCAAP – Connecticut Chapter American Association of Pediatrics; CHA – Connecticut Hospital Association; CNA – Connecticut Nurses' Association; and CSMS – Connecticut State Medical Society.  The Committee is scheduled to convene two or three times after Thanksgiving."  Anne: "CPA has now had three review meetings with our DPH.  At the table were various medical groups.  As expected, they brought up issues of quality and safety.  They made mention to an article about psychologists not prescribing with the underserved as expected in New Mexico.  We are well represented by Barbara, Sharif Okasha, and David Greenfield.  Sharif spoke directly to the underlying issue of access.  He and his father operate an established mental health practice in the New London region.  For two years they have attempted (unsuccessfully) to recruit a psychiatrist or advanced practice nurse to join their practice.  On a personal level, he is very interested in pursuing his masters in psychopharmacology in order to continue working with an underserved area of the state."

            The States of Hawaii and Oregon have the unique experience of having their earlier RxP legislation vetoed by their Governors.  This year Mental Health America of Hawaii listed Prescriptive Authority for Advanced Trained Medical Psychologists (RxP) as its first Access To Care Advocacy Priority.  Kelly Harnick, HPA RxP Chair: "Hawaii is determined.  Fortitude and an unwavering commitment best describes the nature of our RxP Committee.  The Aloha State truly is filled with Aloha in our hearts for our communities.  In Maui country, which includes the islands of Maui, Molokai, and Lana'i, we have an estimated 41-43% psychiatrist shortage.  This is unacceptable for our communities that need access to care.  RxP was re-invigorated in 2015 when the previous Speaker of the House introduced House Bill 1072, after two community advocates and myself met with him in a little coffee shop in Central Maui.  Amazing how an entire movement can ignite over a cup of coffee.  At first, being very green at advocacy, I was shocked that the Speaker even agreed to meet with us.  Politics occurred and our beloved HB 1072 made it through every hurdle until the last 30 seconds of the legislative session of 2016.  Today, we soldier on.  We now have HB 2734 introduced yesterday by the Health and Human Services Chair, Rep. Mizuno.  Our goal is steadfast, and I am beyond grateful for my Committee and their dedication to getting RxP passed for our patients.

            "Hawaii is obviously a bit different than other states because we are an island state.  If you live on a neighbor island you can't just drive to the big city, you have to take a flight.  This means that if you need care that is unavailable, you have to somehow find a way to fly over to Honolulu in order to get the care you need.  As the RxP Chair living on Maui, this is unacceptable for our community.  The legislature opened last week Wednesday, and we are going to work harder than ever before to finally get the RxP bill passed for the people of Hawaii.

"To get a bill passed, it is very important to understand the parliamentary procedures in your state legislature.  It is also very important to empower the people on your committee that are looking up to you for leadership.  It can feel quite pressured because when it comes down to it, you know that you are responsible for advocating for a bill that could save lives.  As the RxP Chair, I always remind myself when it's very easy to get wrapped up in the noise of politics and power, why we are doing this in the first place -- because there are people suffering, going without care.  Our suicide rates are amongst the highest in the country.  Most people would be shocked by learning that.  A common myth is that we simply live in paradise so what is there to be depressed about?  However, psychopathology such as clinical depression, bipolar disorders, anxiety disorders, and PTSD to name a few, don't discriminate even if coconut Palm trees are swaying in the trade winds.  The people of Hawaii are not immune to needing both integrated psychological and psychopharmacological care because they live in 'paradise.'

"Prescribing Medical Psychologists have a value system and clinical approach that the patients are absolutely yearning for: to work with a Doctor who knows them well while engaging in therapy, as well as one who encompasses the medical expertise being able to prescribe medication safely, as well as taper them off medication.  One of the myths and arguments of the opposition that bothers me the most is that RxP is about wanting to prescribe more pills.  It simply is not!

"As a psychologist, our training is very special.  We not only are astute on understanding the therapeutic relationship and the healing power it has; but also therapists with the additional medical knowledge that a prescribing medical psychologist has.  I believe it intimidates the opposition because patients want this kind of treatment from a Doctor they feel truly cares and actually knows them well.  Here in Hawaii, we are now beginning to gear up again, working towards getting this RxP bill through the legislature for yet another time, and as we've heard many times before "If we don't stop we will win" [Louisiana's Jim Quillin].  Hawaii will not stop and we will win for our very special island communities.  As the RxP Chair, I personally will not stop and I feel grateful to have a Committee that is as dedicated as any Chair could ask for."

            Investing in Our Future:  I have just completed two terms of service on the Board on Children, Youth, and Families of the National Academy of Medicine (NAM).  This has been an exhilarating experience, working with dedicated colleagues from a broad range of disciplines, addressing issues directly impacting the wellbeing of our nation's children and their families.  Many of these are fundamental to President Obama's landmark Patient Protection and Affordable Care Act, with its emphasis upon prevention, wellness, and population-oriented approaches to healthcare.  According, it was perhaps surprising to realize, in retrospect, that many of the absolutely critical issues raised during these discussions are ones that previously I only might have superficially contemplated – emphasizing the intellectual limitation of working within comfortable, although isolated, "professional silos."  Psychology is especially fortunate that former APA Congressional Fellow Natacha Blain currently serves as Director for the Board, having recently taken over from another visionary psychologist Kimber Bogard.

            Last year the Board, in conjunction with the National Academies of Science, Engineering, and Medicine, released its consensus study report Promoting the Educational Success of Children and Youth Learning English.  A long-time friend and colleague, Ruby Takanishi, served as Chair of that Committee.  Ruby was formerly President and CEO of the Foundation for Child Development.  She has also served as Director of the APA Office of Scientific Affairs, as well as Executive Director of the Carnegie Council on Adolescent Development.  Highlights:

            Educating Dual language learners and English learners effectively is a national challenge with consequences both for individuals and for American society.  Despite their linguistic, cognitive, and social potential, many English learners – who account for more than 9 percent of enrollment in grades K-12 – are struggling to meet the requirements for academic success, and their prospects for success in post-secondary education and in the workforce are jeopardized as a result.  A defining characteristic of these two groups is their demographic diversity.  They are members of every major racial/ethnic group and include both U.S.- and foreign-born youth.  Most come from Latin America and Asia, with Mexico being their leading country of origin.  Relative to other U.S. children, they are far more likely to live in poverty and in two-parent families with low levels of education.  Nevertheless, those that become proficient in both a home or primary language and English are likely to reap benefits in cognitive, social, and emotional development and may also be protected from brain decline at older ages.  In addition, the cultures, languages, and experiences of English learners are highly diverse and constitute assets for their development, as well as for the nation.

            Both society at large and many educational and health professionals hold competing views about whether dual language learning should be supported early in a child's development and later in school.  Some believe that learning two languages early in life is burdensome; while others believe that young children are "hardwired" to learn one or more languages easily and that nothing needs to be done to promote their language development.  Scientific evidence clearly points to a universal, underlying human capacity to learn two languages as easily as one.  And, the available evidence is mixed as to whether there is a critical period for learning a second language.  Research shows that it can take from five to seven years for students to learn the English necessary for participation in a school's curriculum without further linguistic support.  Native language revitalization is an urgent matter for Native Americans communities. Some, however, unfortunately see this as being in direct conflict with school's efforts to promote English.

It is important to appreciate the long-term consequences for the nation of the reality that a high educational achievement and attainment gap exists between English learners and their monolingual peers.  For example, the reading achievement gap is 36 points at the 4^th -grade level and 44 points at the 8^th -grade level.  The high school graduation rate comparison is 63% -- far lower than the rate for students living in low-income families at 75% -- and the overall national rate of 82%.  Language lies at the center of all human development!  "Indeed, it's the only thing that ever has [Margaret Mead]."  Aloha,

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

 

 

Sent from my iPhone

D29 February column

“NEVER DOUBT THAT A SMALL GROUP OF THOUGHTFUL, COMMITTED CITIZENS CAN CHANGE THE WORLD”

            The very last event which APA President Tony Puente presided over was to personally present the Presidential Citation to former Division 29 President Ron Fox.  “On the closing of the American Psychological Association’s 125^th anniversary, I, Antonio E. Puente, as President of our venerable society bestow upon Ronald E. Fox this APA Presidential citation on December 31, 2017.  From humble beginnings to being President of our great association, Ron Fox has been driven with a vision of making our world a better place through making the profession of psychology a central change agent.  His long and illustrious career has spanned several decades and various settings including as a clinician, a professor, and an advocate for the profession of psychology.  Starting early in his career, Dr. Fox stood firmly for ethnic-minorities, for women, and for the poor, when such advocacy was considered unimportant.

            “Within APA, he has held numerous governance positions from committee member to being President, and a trustee of the Insurance Trust.  Dr. Fox has been a pioneer in so many venues that it is impossible to list them all.  But here are some important illustrations: key in establishing the APA Practice Directorate, Division 29 (Psychotherapy), Division 55 (Psychopharmacology), and the Association of Psychology Postdoctoral and Internship Centers (APPIC).  He advocated in Ohio for the founding of one of the first Doctor of Psychology programs in the U.S.  Dr. Fox was instrumental in establishing one of the first psychology licensing boards in the U.S. (Ohio).  In addition, he is considered the ‘grandfather’ for prescription authority in psychology.

            “Ron Fox has been a calm, steady, and reasoned voice for all of psychology for almost half a century.  For his efforts, his resiliency, his vision, and the many results that have made the profession of psychology what it is today, on this last day of APA’s 125^th anniversary, let it be known that Ronald E. Fox is presented this APA Presidential Citation.”

            Prescriptive Authority (RxP):  From the very beginning, Ron Fox has been a visionary leader in psychology’s quest for prescriptive authority (RxP).  Michael Schwarzchild was one of the first colleagues to respond to Ron’s call.  Although the State of Connecticut was not initially successful, CPA President Anne Klee reports they have once again returned to this important policy agenda.  Former CPA President and RxP committee chair Barbara Bunk: “I am writing with surprising but good news re the RxP effort in Connecticut.  Our Department of Public Health (DPH) has recently informed CPA that our request for review of our scope of practice to include prescriptive authority for appropriately trained psychologists has been accepted.  DPH is now forming a Committee to review and evaluate the request, and to make subsequent recommendations to the Public Health Committee of the Connecticut General Assembly for the 2018 Legislative Session.  The Committee is comprised of the six healthcare organizations that submitted impact statements regarding our request; each organization gets two seats on the Committee, as do we (CPA).  Notably, the Connecticut Psychiatric Society did not appropriately submit, though the DPH Commissioner can indeed appoint additional Committee members if he so chooses – which he subsequently decided to do.

“The six organizations were CTAPRNS – Connecticut Advanced Practice Nurse Society; CCACP – Connecticut Council of Child and Adolescent Psychiatry; CCAAP – Connecticut Chapter American Association of Pediatrics; CHA – Connecticut Hospital Association; CNA – Connecticut Nurses’ Association; and CSMS – Connecticut State Medical Society.  The Committee is scheduled to convene two or three times after Thanksgiving.”  Anne: “CPA has now had three review meetings with our DPH.  At the table were various medical groups.  As expected, they brought up issues of quality and safety.  They made mention to an article about psychologists not prescribing with the underserved as expected in New Mexico.  We are well represented by Barbara, Sharif Okasha, and David Greenfield.  Sharif spoke directly to the underlying issue of access.  He and his father operate an established mental health practice in the New London region.  For two years they have attempted (unsuccessfully) to recruit a psychiatrist or advanced practice nurse to join their practice.  On a personal level, he is very interested in pursuing his masters in psychopharmacology in order to continue working with an underserved area of the state.”

            The States of Hawaii and Oregon have the unique experience of having their earlier RxP legislation vetoed by their Governors.  This year Mental Health America of Hawaii listed Prescriptive Authority for Advanced Trained Medical Psychologists (RxP) as its first Access To Care Advocacy Priority.  Kelly Harnick, HPA RxP Chair: “Hawaii is determined.  Fortitude and an unwavering commitment best describes the nature of our RxP Committee.  The Aloha State truly is filled with Aloha in our hearts for our communities.  In Maui country, which includes the islands of Maui, Molokai, and Lana’i, we have an estimated 41-43% psychiatrist shortage.  This is unacceptable for our communities that need access to care.  RxP was re-invigorated in 2015 when the previous Speaker of the House introduced House Bill 1072, after two community advocates and myself met with him in a little coffee shop in Central Maui.  Amazing how an entire movement can ignite over a cup of coffee.  At first, being very green at advocacy, I was shocked that the Speaker even agreed to meet with us.  Politics occurred and our beloved HB 1072 made it through every hurdle until the last 30 seconds of the legislative session of 2016.  Today, we soldier on.  We now have HB 2734 introduced yesterday by the Health and Human Services Chair, Rep. Mizuno.  Our goal is steadfast, and I am beyond grateful for my Committee and their dedication to getting RxP passed for our patients.

            “Hawaii is obviously a bit different than other states because we are an island state.  If you live on a neighbor island you can’t just drive to the big city, you have to take a flight.  This means that if you need care that is unavailable, you have to somehow find a way to fly over to Honolulu in order to get the care you need.  As the RxP Chair living on Maui, this is unacceptable for our community.  The legislature opened last week Wednesday, and we are going to work harder than ever before to finally get the RxP bill passed for the people of Hawaii.

“To get a bill passed, it is very important to understand the parliamentary procedures in your state legislature.  It is also very important to empower the people on your committee that are looking up to you for leadership.  It can feel quite pressured because when it comes down to it, you know that you are responsible for advocating for a bill that could save lives.  As the RxP Chair, I always remind myself when it’s very easy to get wrapped up in the noise of politics and power, why we are doing this in the first place -- because there are people suffering, going without care.  Our suicide rates are amongst the highest in the country.  Most people would be shocked by learning that.  A common myth is that we simply live in paradise so what is there to be depressed about?  However, psychopathology such as clinical depression, bipolar disorders, anxiety disorders, and PTSD to name a few, don’t discriminate even if coconut Palm trees are swaying in the trade winds.  The people of Hawaii are not immune to needing both integrated psychological and psychopharmacological care because they live in ‘paradise.’

“Prescribing Medical Psychologists have a value system and clinical approach that the patients are absolutely yearning for: to work with a Doctor who knows them well while engaging in therapy, as well as one who encompasses the medical expertise being able to prescribe medication safely, as well as taper them off medication.  One of the myths and arguments of the opposition that bothers me the most is that RxP is about wanting to prescribe more pills.  It simply is not!

“As a psychologist, our training is very special.  We not only are astute on understanding the therapeutic relationship and the healing power it has; but also therapists with the additional medical knowledge that a prescribing medical psychologist has.  I believe it intimidates the opposition because patients want this kind of treatment from a Doctor they feel truly cares and actually knows them well.  Here in Hawaii, we are now beginning to gear up again, working towards getting this RxP bill through the legislature for yet another time, and as we’ve heard many times before “If we don’t stop we will win” [Louisiana’s Jim Quillin].  Hawaii will not stop and we will win for our very special island communities.  As the RxP Chair, I personally will not stop and I feel grateful to have a Committee that is as dedicated as any Chair could ask for.”

            Investing in Our Future:  I have just completed two terms of service on the Board on Children, Youth, and Families of the National Academy of Medicine (NAM).  This has been an exhilarating experience, working with dedicated colleagues from a broad range of disciplines, addressing issues directly impacting the wellbeing of our nation’s children and their families.  Many of these are fundamental to President Obama’s landmark Patient Protection and Affordable Care Act, with its emphasis upon prevention, wellness, and population-oriented approaches to healthcare.  According, it was perhaps surprising to realize, in retrospect, that many of the absolutely critical issues raised during these discussions are ones that previously I only might have superficially contemplated – emphasizing the intellectual limitation of working within comfortable, although isolated, “professional silos.”  Psychology is especially fortunate that former APA Congressional Fellow Natacha Blain currently serves as Director for the Board, having recently taken over from another visionary psychologist Kimber Bogard.

            Last year the Board, in conjunction with the National Academies of Science, Engineering, and Medicine, released its consensus study report Promoting the Educational Success of Children and Youth Learning English.  A long-time friend and colleague, Ruby Takanishi, served as Chair of that Committee.  Ruby was formerly President and CEO of the Foundation for Child Development.  She has also served as Director of the APA Office of Scientific Affairs, as well as Executive Director of the Carnegie Council on Adolescent Development.  Highlights:

            Educating Dual language learners and English learners effectively is a national challenge with consequences both for individuals and for American society.  Despite their linguistic, cognitive, and social potential, many English learners – who account for more than 9 percent of enrollment in grades K-12 – are struggling to meet the requirements for academic success, and their prospects for success in post-secondary education and in the workforce are jeopardized as a result.  A defining characteristic of these two groups is their demographic diversity.  They are members of every major racial/ethnic group and include both U.S.- and foreign-born youth.  Most come from Latin America and Asia, with Mexico being their leading country of origin.  Relative to other U.S. children, they are far more likely to live in poverty and in two-parent families with low levels of education.  Nevertheless, those that become proficient in both a home or primary language and English are likely to reap benefits in cognitive, social, and emotional development and may also be protected from brain decline at older ages.  In addition, the cultures, languages, and experiences of English learners are highly diverse and constitute assets for their development, as well as for the nation.

            Both society at large and many educational and health professionals hold competing views about whether dual language learning should be supported early in a child’s development and later in school.  Some believe that learning two languages early in life is burdensome; while others believe that young children are “hardwired” to learn one or more languages easily and that nothing needs to be done to promote their language development.  Scientific evidence clearly points to a universal, underlying human capacity to learn two languages as easily as one.  And, the available evidence is mixed as to whether there is a critical period for learning a second language.  Research shows that it can take from five to seven years for students to learn the English necessary for participation in a school’s curriculum without further linguistic support.  Native language revitalization is an urgent matter for Native Americans communities. Some, however, unfortunately see this as being in direct conflict with school’s efforts to promote English.

It is important to appreciate the long-term consequences for the nation of the reality that a high educational achievement and attainment gap exists between English learners and their monolingual peers.  For example, the reading achievement gap is 36 points at the 4^th -grade level and 44 points at the 8^th -grade level.  The high school graduation rate comparison is 63% -- far lower than the rate for students living in low-income families at 75% -- and the overall national rate of 82%.  Language lies at the center of all human development!  “Indeed, it’s the only thing that ever has [Margaret Mead].”  Aloha,

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

 

 

HPA - January, 2018

“IF LIFE IS FAIR WHY DOES ROSES HAVE THORNS”

            I have now served two terms on the National Institute of Medicine (NAM) Board on Children, Youth, and Families.  This has been a fascinating opportunity to work with colleagues from a number of diverse disciplines on behalf of our nation’s children.  Psychology is very fortunate that former APA Congressional Fellow Natacha Blain serves as Director of the Board, as the behavioral sciences have much to offer to these critical deliberations.  This summer the Board released the proceedings of its workshop Training the Future Child Health Care Workforce to Improve Behavioral Health Outcomes for Children, Youth, and Families.

            “Childhood diagnoses of cognitive, affective, and behavioral disorders are increasing in both absolute numbers and as a proportion of the total childhood population in the United States, and they are imposing a large and growing burden on children, youth, and families.  However, the adoption of evidence-based interventions that have proven effective in preventing and treating behavioral health disorders in children has been slow.  A contributing factor for this slow adoption may be that current training in many fields involving the behavioral health of children is falling short of meeting their needs.”  Highlights of the proceedings:

            The workforce involved in promoting children’s cognitive, affective, and behavioral health is broad and varied, including pediatricians, adult and child psychiatrists, family medicine physicians, obstetricians and gynecologists, nurses, social workers, community and public health professionals, and parents who have been trained to fill professional roles.  Nevertheless, there is a workforce crisis due to an increased demand for behavioral health services, too few workers to meet the demand, a poorly distributed workforce, a need for additional training, an increased emphasis on integrated team-based care and treatment of co-occurring disorders, and a lack of systematic workforce data collection.  Overall, the expected shortage of trained professionals will continue to be substantial through 2025, notwithstanding that currently over 900,000 licensed professionals work in behavioral health.  “The total shortage in the selected behavioral health occupations is projected to be about a quarter million workers.  In addition, the workforce is aging, more workers are needed in rural areas, the workforce needs to become more diverse, and people serving specialized populations need more specialized training.”

APA was represented by Doug Tynan who emphasized that all mental health providers need to receive training in delivering effective, evidence-based therapies in primary care settings – an underlying tenant of President Obama’s Affordable Care Act (ACA).  Former APA President Susan McDaniel presented on Interprofessional training bringing together Psychology Post-doctoral fellows and pediatric and family medicine residents and fellows.  She described the two-year curriculum that includes seminars, experiential exercises, supervision, and collaborative practice in their integrated primary care clinics.  At the end of her presentation a leader in pediatrics stood up and said: “This is amazing!  Why isn’t this implemented all over the country?”  Why not indeed?  One projection that I fundamentally disagree with is: “(S)hortages will continue to be substantial… in all the professions except behavioral health nurse practitioners and physician assistants.”  As the nation’s health care environment continues to evolve towards integrated primary care systems (e.g., the ACA’s Accountable Care Organizations and Patient-Centered Medical Homes) we expect that these two disciplines will become increasingly important in providing necessary care and policy development.

It is exciting to work with colleagues who appreciate the “bigger picture.”  Under the leadership of former USPHS chief nurse Dean Carol Romano, the USU Daniel K. Inouye Graduate School of Nursing has placed one of their DNP graduate students at the Lana’i Federally Qualified Community Health Center (LCHC).  CEO Diana Shaw: “We recently formed a relationship with USU bringing with it a shared opportunity for learning and new experiences.  U.S. Navy LCDR Kayla R. Horton started her internship with LCHC this month.  She is excited to be with us and is learning and sharpening her skills as a future APRN in a rural, remote diverse setting.  This experience is unique and provides her with access to a full range of family practice issues and the use of tele-medicine – especially services that she might not get in her military career, such as working with a medically underserved population on a small rural island.  Kayla is also exposed to the cultural diversity of our community, which will add enhanced cultural sensitivity to her arsenal of health care tools.  From our perspective, we are gaining additional experience with our workforce development program and honing our contribution to the educational preparation of health care professionals by allowing faculty and students to participate in our activities and live within our small community.  Overall our joint efforts and combined resources work to develop, improve, and sustain the delivery of outstanding medical, dental, nursing, and clinical care and preventive medicine.”

            Over the nearly four decades of working with Senator Inouye, I came to appreciate that substantive change always takes time and is usually based upon foundations that have been built by often unappreciated visionaries.  In March, 2010, then-U.S. Army Surgeon General Eric Schoomaker, currently on the USU faculty, testified before the Senator regarding the status of Army Medicine.  “I am in awe at what these selfless servants have done over the past years – their accomplishments have been quietly, effectively, powerfully successful.  While we have experienced our share of crises and even tragedies, despite eight years of continuous armed conflict for which Army Medicine bears a heavy load, every day our Soldiers and their Families are kept from injuries, illnesses, and combat wounds through our health promotion and prevention efforts; are treated in cutting-edge fashion when prevention fails; and are supported by an extraordinarily talented medical force.”

            A number of his underlying themes were reflected in the ACA and the NAM proceedings.  ”The first strategic theme – Maximize Value in Health Services – is built on the belief that providing high quality, evidence-based services is not only right for our Soldiers and Families; it results in the most efficient use of resources within the healthcare system, thus delivering value to not only our Patients, but indeed, the Nation.  In fact, what we really want to do is move from a healthcare system to a system for health….  This requires focusing on the clinical outcome for the patient and the community and maintaining or even reducing the overall resource expenditure needed to achieve this objective.  It has occurred through adoption of evidence-based practices and reducing unwarranted practice variation.”  He stressed the importance of improving physical and psychological health promotion and prevention, the value of the Patient-Centered Medical Home approach, and the appropriateness of his Mental Health Advisory Team’s recommendations to develop military-specific models for identifying and addressing “provider fatigue” as the military equivalent of compassion fatigue.  Focusing upon evidence-based practice, he noted the Virtual Behavioral Health Pilot (aka Comprehensive Behavioral Health Integration) being conducted at Schofield Barracks and Ft. Richardson.  “To transform from a healthcare system to a system for health, we need to change the social contract.  No longer should we be paid for building widgets (number of clinic visits or procedures), rather, we should be paid for preventing illness and promoting healthy lifestyles.”  Personally, I have the deepest appreciation for the service and dedication of former HPA President and APA Congressional Fellow Debra Dunivin during her tenure in the U.S. Army.  [Elmo].  Aloha,

Pat DeLeon, former APA President – HPA – January, 2018

 

PROGRESS IS IMPOSSIBLE WITHOUT CHANGE

 Give an Hour:  When one reflects upon the contributions of visionary (and unsurprisingly, frequently selfless) colleagues, Give an Hour truly stands out.  To date, Barbara Van Dahlen's pioneering efforts have resulted in more than 124,000 hours of free mental and behavioral health care and support, valued at nearly $23 million, being provided by volunteer mental health professionals to active duty military personnel, Veterans, and their families.  She has recently expanded her efforts to address the needs of those impacted by this year's extraordinary series of natural and man-made disasters, including Hurricane Harvey, as well as other populations who clearly are in need – including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.  Give an Hour has effectively responded to the trauma of Charlottesville and has begun to partner with the Red Cross to be able to effectively address yet unknown future traumatic events.  From my perspective, Barbara has been unusually sensitive to the long-term importance of involving our next generation of behavioral health clinicians throughout this journey.  The reflections of graduate students in psychology and psychiatric mental health nursing from the Uniformed Services University (USU), whom she has thereby mentored:

            "As part of the annual 'Celebration of Service,' Dr. Barbara Van Dahlen and her non-profit organization hosted a screening of the new film Into the Light by documentary filmmaker Charles Stuart.  The film features Barbara on her search to find her mother, who was diagnosed with schizophrenia soon after Barbara's birth and whom she had not seen in decades.  Her story was juxtaposed with the run across America to raise awareness for Veterans completed by former Marine Sgt. Brendan O'Toole.  Both Brendan and Barbara shared their experiences in finding themselves and learning to trust others enough to share their stories, in the words of eight-time Emmy Award winning filmmaker Chares Stuart.  The screening was held at the National Geographic Museum in Washington, D.C., and followed by a discussion panel with Charles, Brendan, and Barbara.  In line with the differing stories throughout the film, the discussion went in many different directions.  The audience members learned how they could share the film so others might become more aware of Veterans' issues and the impact of mental illness and mental health stigma on families and communities.  Many personal stories of thanks and support were shared.  Those present were encouraged to advocate for their own mental health needs, and for those of others.

"Barbara set a wonderfully important example in facing personal mental health experiences within her family as well as her own internalized self-stigma, which is an important journey for anyone in the business of helping others face their own demons.  Brendan exemplified the persistence of service members in fighting for themselves – choosing to run across America in an effort to heal himself from invisible wounds and raise awareness of the struggles service members face when they return home and into the medical system.  Together, and with the help of creative minds, they created a touching film which will be available for free download in January at www.giveanhour.org and will air on PBS in May, 2018, for Mental Health Awareness Month.  Give an Hour champions a change in culture surrounding mental health."  [Hannah Martinez, 1LT, USA; psychology graduate student].

            "I felt privileged to attend the premiere of Charles Stuart's latest documentary over the Veterans Day weekend.  Having attended several events for Give an Hour and the Campaign to Change Direction in the past, I wasn't surprised to see a film about mental health on the agenda for this year's 'Celebration of Service.'  What WAS surprising was how Mr. Stuart was able to weave two seemingly different and deeply personal stories into one riveting film.  Into the Light follows USMC Veteran Brendan O'Toole as he sets out to run 3,600 miles across the United States to raise money and awareness about depression and combat-related mental issues facing so many of our service members.  As his story unfolds, the film also introduces us to Barbara Van Dahlen, whom many in our field know as the dynamic founder and tireless advocate for Give an Hour and its associated causes.  What they may not know, however, is her personal story of battling mental illness within her own family.  It is a story of reluctance, realization, determination, heartbreak, and redemption.

            "Two of the ties that bind Brendan's and Barbara's stories are courage and stigma.  Although their stories and paths are very different, they both battled the stigma surrounding mental illness, and had the courage to realize that talking about it was the only way to help others facing similar circumstances.  Interestingly, both Marines and Mental Health Professionals have, in the past, been reluctant to share too much about their personal stories… it has been frowned upon and often even advised against, in professional and leadership training.  Into the Lighthumanizes both professions, highlighting the struggles that unite us.  As Barbara mentioned in the film, 'Our similarities far outweigh our differences.'  This film was an excellent reminder that all of us – providers, patients, family, friends, and colleagues -- are fighting a shared battle.  I encourage everyone to share this film far and wide when it is released!"  [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].  Have you volunteered for Give an Hour?

            The National Academies of Sciences, Engineering, and Medicine:  This year I will complete my service on the National Academies Board on Children, Youth, and Families where former APA Congressional Science Fellow Natacha Blain serves as the Board Director.  The Board's mission is to convene top experts from multiple disciplines to analyze the best available evidence on crucial issues facing children, youth, and families today.  With the ability to evaluate research simultaneously from the perspectives of the biological, behavioral, health, and social sciences, the board seeks to shed light on innovative and influential solutions to inform the nation in a timely fashion.  A major goal is to make the largest possible impact on the health and well-being of children, youth, and their families throughout their entire lifecycle.  Increasingly, similar to Barbara Van Dahlen's vision, efforts have been made to "change the conversation" surrounding health care to move beyond traditional individual-focused "medical care" and fully recognize the critical importance of the psychosocial-cultural-economic gradient of "wellbeing."  Without access to adequate housing, transportation, physical safety, and reasonable economic resources, one cannot expect our nation's health disparities to be successfully addressed.  Without fostering quality interprofessional education at the earliest stages of professional development, one cannot realistically expect the next generation of professionals to value and respect their colleagues.  During her 2016 APA Presidency, Susan McDaniel made integrated care and collaborative team practice a high priority for APA, reflecting their fundamental status within President Obama's landmark Patient Protection and Affordable Care Act (ACA).

Attuned to the importance of data-influenced policy decisions, the board has been systematically exploring the unprecedented impact of technology and the media on our society's deliberations and on its policies impacting children, youth, and families.  Although promoting the value of evidence-based policy, the board fully recognizes that this is not universally appreciated within or outside of the nation's Capital.  There has also been the increasing recognition that major policy decisions are steadily being established at the state and local level, rather than at the federal level (i.e., devolution).  These are, indeed, challenging times which provide extraordinary opportunities for those with vision and dedication.  "And those who cannot change their minds cannot change anything."  Aloha.

Pat DeLeon, former APA President – HPA -- December, 2017

 

Sent from my iPhone

ALOHA - HPA

“PROGRESS IS IMPOSSIBLE WITHOUT CHANGE”

            Give an Hour:  When one reflects upon the contributions of visionary (and unsurprisingly, frequently selfless) colleagues, Give an Hour truly stands out.  To date, Barbara Van Dahlen’s pioneering efforts have resulted in more than 124,000 hours of free mental and behavioral health care and support, valued at nearly $23 million, being provided by volunteer mental health professionals to active duty military personnel, Veterans, and their families.  She has recently expanded her efforts to address the needs of those impacted by this year’s extraordinary series of natural and man-made disasters, including Hurricane Harvey, as well as other populations who clearly are in need – including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.  Give an Hour has effectively responded to the trauma of Charlottesville and has begun to partner with the Red Cross to be able to effectively address yet unknown future traumatic events.  From my perspective, Barbara has been unusually sensitive to the long-term importance of involving our next generation of behavioral health clinicians throughout this journey.  The reflections of graduate students in psychology and psychiatric mental health nursing from the Uniformed Services University (USU), whom she has thereby mentored:

            “As part of the annual ‘Celebration of Service,’ Dr. Barbara Van Dahlen and her non-profit organization hosted a screening of the new film Into the Light by documentary filmmaker Charles Stuart.  The film features Barbara on her search to find her mother, who was diagnosed with schizophrenia soon after Barbara’s birth and whom she had not seen in decades.  Her story was juxtaposed with the run across America to raise awareness for Veterans completed by former Marine Sgt. Brendan O’Toole.  Both Brendan and Barbara shared their experiences in finding themselves and learning to trust others enough to share their stories, in the words of eight-time Emmy Award winning filmmaker Chares Stuart.  The screening was held at the National Geographic Museum in Washington, D.C., and followed by a discussion panel with Charles, Brendan, and Barbara.  In line with the differing stories throughout the film, the discussion went in many different directions.  The audience members learned how they could share the film so others might become more aware of Veterans’ issues and the impact of mental illness and mental health stigma on families and communities.  Many personal stories of thanks and support were shared.  Those present were encouraged to advocate for their own mental health needs, and for those of others.

“Barbara set a wonderfully important example in facing personal mental health experiences within her family as well as her own internalized self-stigma, which is an important journey for anyone in the business of helping others face their own demons.  Brendan exemplified the persistence of service members in fighting for themselves – choosing to run across America in an effort to heal himself from invisible wounds and raise awareness of the struggles service members face when they return home and into the medical system.  Together, and with the help of creative minds, they created a touching film which will be available for free download in January at www.giveanhour.org and will air on PBS in May, 2018, for Mental Health Awareness Month.  Give an Hour champions a change in culture surrounding mental health.”  [Hannah Martinez, 1LT, USA; psychology graduate student].

            “I felt privileged to attend the premiere of Charles Stuart’s latest documentary over the Veterans Day weekend.  Having attended several events for Give an Hour and the Campaign to Change Direction in the past, I wasn’t surprised to see a film about mental health on the agenda for this year’s ‘Celebration of Service.’  What WAS surprising was how Mr. Stuart was able to weave two seemingly different and deeply personal stories into one riveting film.  Into the Light follows USMC Veteran Brendan O’Toole as he sets out to run 3,600 miles across the United States to raise money and awareness about depression and combat-related mental issues facing so many of our service members.  As his story unfolds, the film also introduces us to Barbara Van Dahlen, whom many in our field know as the dynamic founder and tireless advocate for Give an Hour and its associated causes.  What they may not know, however, is her personal story of battling mental illness within her own family.  It is a story of reluctance, realization, determination, heartbreak, and redemption.

            “Two of the ties that bind Brendan’s and Barbara’s stories are courage and stigma.  Although their stories and paths are very different, they both battled the stigma surrounding mental illness, and had the courage to realize that talking about it was the only way to help others facing similar circumstances.  Interestingly, both Marines and Mental Health Professionals have, in the past, been reluctant to share too much about their personal stories… it has been frowned upon and often even advised against, in professional and leadership training.  Into the Light humanizes both professions, highlighting the struggles that unite us.  As Barbara mentioned in the film, ‘Our similarities far outweigh our differences.’  This film was an excellent reminder that all of us – providers, patients, family, friends, and colleagues -- are fighting a shared battle.  I encourage everyone to share this film far and wide when it is released!”  [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].  Have you volunteered for Give an Hour?

            The National Academies of Sciences, Engineering, and Medicine:  This year I will complete my service on the National Academies Board on Children, Youth, and Families where former APA Congressional Science Fellow Natacha Blain serves as the Board Director.  The Board’s mission is to convene top experts from multiple disciplines to analyze the best available evidence on crucial issues facing children, youth, and families today.  With the ability to evaluate research simultaneously from the perspectives of the biological, behavioral, health, and social sciences, the board seeks to shed light on innovative and influential solutions to inform the nation in a timely fashion.  A major goal is to make the largest possible impact on the health and well-being of children, youth, and their families throughout their entire lifecycle.  Increasingly, similar to Barbara Van Dahlen’s vision, efforts have been made to “change the conversation” surrounding health care to move beyond traditional individual-focused “medical care” and fully recognize the critical importance of the psychosocial-cultural-economic gradient of “wellbeing.”  Without access to adequate housing, transportation, physical safety, and reasonable economic resources, one cannot expect our nation’s health disparities to be successfully addressed.  Without fostering quality interprofessional education at the earliest stages of professional development, one cannot realistically expect the next generation of professionals to value and respect their colleagues.  During her 2016 APA Presidency, Susan McDaniel made integrated care and collaborative team practice a high priority for APA, reflecting their fundamental status within President Obama’s landmark Patient Protection and Affordable Care Act (ACA).

Attuned to the importance of data-influenced policy decisions, the board has been systematically exploring the unprecedented impact of technology and the media on our society’s deliberations and on its policies impacting children, youth, and families.  Although promoting the value of evidence-based policy, the board fully recognizes that this is not universally appreciated within or outside of the nation’s Capital.  There has also been the increasing recognition that major policy decisions are steadily being established at the state and local level, rather than at the federal level (i.e., devolution).  These are, indeed, challenging times which provide extraordinary opportunities for those with vision and dedication.  “And those who cannot change their minds cannot change anything.”  Aloha.

Pat DeLeon, former APA President – HPA -- December, 2017