ALOHA - Div 18

THE CONTINUING HIGHLIGHT OF THE YEAR

            We recently had the opportunity to attend the 2018 APAPO Practice Leadership Conference, joining 350 colleagues from all over the nation and Columbia.  This was Executive Director for Professional Practice Katherine Nordal’s farewell event – Advancing Practice Together and her opportunity to formally introduce Arthur Evans, APA’s new CEO, to the leadership of our State and Territorial psychological associations – the backbone of professional practice.  At the Opening Session there was a solemn moment of silence for our California VA colleagues who were killed earlier that week, serving those who had placed themselves in “Harm’s Way.”  Then the enthusiasm in the room and the genuine appreciation and gratitude that those assembled felt for Katherine’s extraordinary decade of service at APA spontaneously burst forth.

The Times They Are A-Changing:  Our profession is undergoing an unprecedented transformation, as is the nation’s entire health care system.  As Katherine touched upon the highlights of her journey at APA – achieving mental health parity, protecting against proposed Medicare and Medicaid cuts which would have negatively impacted psychology’s patients, fighting for increasing psychology’s recognition at the federal and local level, etc. -- she made it clear that she had enjoyed creating the type of disruption within the profession that ultimately allowed us to believe in ourselves and remove our historical blinders, in order to move the profession to a higher level of accomplishment.  She stressed that psychology will only achieve its true potential by addressing society’s real needs and by appreciating that we can indeed make people and society healthier and happier.  Psychology does save lives.  Katherine was clear that Arthur Evans was absolutely the right person for psychology at this point in time and was very optimistic about the future.  For me personally, the State Leadership conferences are the highlight of the year and this year’s 35^th was no exception.  If you have the opportunity to represent your state, I would strongly recommend it.  It is an exhilarating experience.

Several major themes were consistently expressed throughout the conference, such as the importance of developing genuine personal relationships at the local level with our state and federal elected officials.  I was particularly pleased to be in the audience for Doug Walter’s “Inside Congress and the 2018 Mid-Year Political Landscape” political plenary session where the chiefs of staff for Senators Heidi Heitkamp (D-ND) and Michael Crapo (R-ID) shared their extensive experiences on The Hill.  The importance of bi-partisan collaboration, hiring excellent staff and then staying out of their way, and having a long-term vision have not changed since I was there.  Having a conversation with colleagues, and thereby building trusting relationships, remains the key to success.  Money is unquestionably important in the political process; however, very few legislative staff are actually aware of who makes contributions.  At the luncheon awards program the recipient, a Nebraska State Senator, made the same points -- stressing how his psychology constituents have been with him from the very beginning and how they are constantly educating him regarding psychology’s contributions to early childhood education and juvenile justice programs.  As a businessman-banker he was very impressed by the cost-effectiveness of prevention initiatives, particularly for those on the verge of entering the prison system.  Again, long term relationships are the key to access and influence.

Prescriptive Authority (RxP):  Beth Rom-Rymer, currently serving on the APA Board of Directors, chaired one of the concurrent workshops: “The Revolution in Health Care: Prescribing Psychologists.”  The excitement for the future was palpable, as first-hand descriptions of the various successful models adopted by New Mexico, Louisiana, Illinois, Iowa, and Idaho were described.  Renee Willkins from New Mexico reported that they now have 10 prescribing psychologists who have been in practice for over a decade; she and Darlyne Nemeth of Louisiana reported that to their knowledge, there have been no reported complaints to their respective licensing boards.  Further, they both emphatically addressed the reoccurring concern that those who obtained RxP might lose their psychology identity by stating that simply was not correct.  All of their prescribing colleagues saw themselves first as psychologists and appreciated how they were able to significantly improve the lives of their patients, frequently by modifying previous medication orders.  Each successful state had adopted a legislative strategy that was unique to their own circumstances and especially the pressing needs of their rural citizens.

“What is particularly unique is that Illinois graduate students are flocking to the Chicago School of Professional Psychology to earn a Master’s degree in Clinical Psychopharmacology alongside their doctoral degrees in Psychology.  It is really exciting that the APA Committee, chosen to review the Clinical Psychopharmacology curriculum for prescribing psychology trainees, has recommended that APA approve the training of graduate students in Clinical Psychopharmacology.  This recommendation would give significant impetus to those thousands of graduate students, around the country, who are passionate about becoming psychologists and who believe that having prescriptive authority would give them greater access to a wider range of tools to be utilized in treatment” (Beth Rom-Rymer).

            The Master’s Issue:  One far-reaching accomplishment by the Council of Representatives, which met that same week in our nation’s Capital, was highlighted at the APAPO conference.  “APA is currently recognized by the United States Secretary of Education to accredit doctoral, internship, and postdoctoral programs in psychology.  At the March 2018 APA Council of Representatives meeting a motion was overwhelmingly approved to pursue accreditation of master’s level programs in psychology in areas where APA accreditation now applies (clinical, counseling, school, and combinations thereof).  Factors that were considered in making this decision include the growth in the number of master’s degrees awarded in psychology by 40% in both health service and research subfields between 2006 and 2016 and the importance of master’s programs in ensuring the viability of doctoral programs.  Furthermore, graduates with master’s degrees in psychology are facing increasing challenges to get credentialed for practice secondary to advocacy efforts to restrict the professional counselor credential to those who have graduated from a program accredited by the Council on Accreditation of Counseling and Related Educational Programs (CACREP).  This challenge has grown despite the existence of a separate accreditation system for psychology graduates (the Master’s in Psychology and Counseling Accreditation Council).

“It is important to note that this action was taken with the continued recognition of the doctorate is the minimum educational requirement for entry into professional practice as a psychologist.  Next steps will include developing a proposal regarding the decision-making structure of the accrediting body, how that body will need to be developed in accordance with current APA policies, scope of accreditation for that body, a timeframe to develop standards, policies, and procedures for program review, timeframe to seek recognition (federal and or non-federal), and infrastructure issues” (Catherine Grus).  This is a critical issue for all of psychology which was discussed in depth by Linda Campbell and her colleagues at last year’s annual convention.  When I served as APA President in 2000, we seriously explored various potential options.  However, at that time it was not possible to develop the necessary consensus for action.  Substantive change always takes time, often far longer than one might anticipate.

            The American Academy of Nursing:  Long-time psychology colleague Angelia McBride, Dean Emerita of the Indiana-Purdue University School of Nursing and a Nursing “Living Legend,” invited me to serve on the AAN-Institute for Nursing Leadership National Advisory Council.  Their Advisory Council met the same week as State Leadership and it was inspiring to participate in very similar discussions with nursing’s leadership regarding how to best serve society and bring their considerable expertise to the table in addressing such societal priorities as decreasing violence, especially within our nation’s schools.  As Angie emphasized during their deliberations, the public policy process requires interdisciplinary collaboration.  Mahalo, Katherine Nordal -- Psychology’s “Living Legend.”  Aloha,

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

 

AS THERE IS NO CURE, THERE SEEMS NO PLACE FOR A DOCTOR’S SKILL

   Interprofessional Dialogue:  One of the most enjoyable aspects of being involved with the National Academy of Medicine (NAM) of the National Academies of Sciences, Engineering, and Medicine is the opportunity to interact with colleagues from a wide range of disciplines while addressing issues that are of importance to our nation.  This year I was fortunate to have been appointed to the NAM Culture of Health Program Advisory Committee and received a copy of the Academies' intriguing 2017 report Communities in action: Pathways to health equity.  Coming from a psychology-legal orientation, there are elements of their report that I would enthusiastically endorse; and not surprisingly, there are perspectives expressed which with which I am admittedly less comfortable.  Highlights:

            "Health equity is the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance.  Health equity and opportunity are inextricably linked.  Currently in the United States, the burdens of disease and poor health and the benefits of well-being and good health are inequitably distributed.  This inequitable distribution is caused by social, environmental, economic, and structural factors that shape health and are themselves distributed unequally, with pronounced differences in opportunities for health."

            The report notes that health equity is fundamental to a good life and a vibrant society due to its practical, economic, and civic implications.  Further, health inequity is very costly.  It is estimated that eliminating health disparities for minorities would have resulted in reduced direct medical care costs by nearly $230 billion for the years 2003-2006.  From a national security perspective, nearly one third (32 percent) of all young people experience health problems – other than their weight – that would keep them from serving in the military.  Infant mortality, age-adjusted death rates, and life expectancy are considered critical to judging the overall health of a population.  In international rankings, the U.S. ranks lower than other wealthy nations on each of these indicators – while spending considerably more.

            The Academies' report identified nine social determinants of health: education, employment, health systems and services, housing, income and wealth, physical environment, public safety, social environment, and transportation.  "Based on its review of the evidence, the committee concludes that health inequities are the result of more than individual choice or random occurrence.  They are the result of the historic and ongoing interplay of inequitable structures, policies, and norms that shape lives."  And, "In the committee's judgment, civil rights approaches have helped mitigate the negative impacts of many forms of social and health discrimination.  Continuing this work is needed to overcome discrimination and the structural barriers that affect health."

            Where I do have a different perspective from that of the committee on achievable priorities relates to their conclusion: "For many years researchers, public health practitioners, and others have known that health status in this country and around the world is determined as much by socioeconomic as biologic or behavioral factors.  Despite that recognition, approaches to improving health status and health outcomes have narrowly centered on improving medical interventions, technologies, systems, and access.  Beyond clinical approaches, some health promotion strategies have focused on changing behavior, despite the robust evidence indicating that they are ineffective in addressing health inequities.  Although these strategies play a role in improving population health, it has become amply clear that they are necessary but not sufficient.  Health is the result of much more than health care; the social, economic, environmental and structural factors – for example, education, poverty, housing, and structural racism – that shape health outcomes also create health inequities.  Addressing and putting an end to health inequities will only be possible if society and decision makers broaden their view of health to fully grasp how steep and unjust disparities in social and other conditions limit, thwart, and even destroy some people's ability to live healthy and full lives."  From my perspective, the committee did not go far enough in recognizing and reaching out to psychology and a number of other disciplines which can, and shall, contribute significantly to this important dialogue.

            Interprofessional Collaboration:  Ken Pope recently shared with us a John Hopkins Bloomberg School of Public Health comparison of the quality of physician, Nurse Practitioner (NP), and Physician Assistant (PA) prescribing protocols, covering over 700,000 patient visits.  They examined 13 quality indicators across a range of chronic diseases, including antibiotic use and concurrent prescription of contraindicated medications.  The conclusion: the quality of prescribing was similar across the board and while there was room for improvement in all of their indicators, no one discipline was more likely than another to be nonadherent with guidelines.  NPs and PAs continue to be one solution to physician shortages, with data such as this providing support for their growing autonomy and prescriptive authority.

            "Over the past few years, the Psychiatric Mental Health Nurse Practitioner Doctor of Nursing Practice (DNP) program and the Psychology program at the Uniformed Services University (USU) have increasingly engaged in interprofessional education activities.  Our first effort was our joint Health Policy class exposing graduate students from both disciplines to a wide range of accomplished speakers describing their personal journeys.  These included APA's Heather Kelly and Steve Behnke; former APA Presidents Ron Fox, Barry Anton, and Don Bersoff; current and former Surgeon Generals and VA Secretaries; as well as a former Prisoner of War.  Dialogue between our disciplines increased and psychology faculty began assisting with topics in the GSN Therapeutic Modalities course, including presentations on cognitive behavioral therapy and biofeedback.  Psychology faculty and graduate students have helped supervise DNP students at the university's simulation center.  Students from both programs train together and are placed in joint teams at Operation Bushmaster, a large scale simulated operational field training exercise, where they see simulated mental health patients, perform a mock unit needs assessment, and assist with operational stress control.  Psychology students are invited to participate in our Wilderness Medicine field experiences.  Most recently, GSN faculty were selected to teach in the psychopharmacology course for clinical psychology students.  We are now working to start a joint psychotropic interest group, which will involve case-based presentations, and to collaborate on leadership development" [CDR Eric Pauli, USN, NC].

            "I am thrilled to see that the APA Committee, formed to review the Clinical Psychopharmacology Curriculum for prescribing psychology trainees, has recommended that the didactic training can be done at the graduate, predoctoral level.  Certainly, our Illinois graduate students are thrilled with the opportunity to do their training in Clinical Psychopharmacology, as a joint Master's degree, alongside their doctorate in Psychology.  It is most satisfying that our profession continues to move forward, striving to meet the needs of our psychology students as well as the needs of our larger community" [Beth Rom-Rymer, APA Board of Directors, Council Leadership Team].  In enacting the 2014 Illinois Psychological Association RxP legislation, Beth and her colleagues worked tirelessly in developing a broad based, interprofessional coalition enthusiastically supporting their bill on behalf of the entire community.  [Father Damien].  Aloha,

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

 

Sent from my iPhone

ALOHA - HPA

“AS THERE IS NO CURE, THERE SEEMS NO PLACE FOR A DOCTOR’S SKILL”

            Interprofessional Dialogue:  One of the most enjoyable aspects of being involved with the National Academy of Medicine (NAM) of the National Academies of Sciences, Engineering, and Medicine is the opportunity to interact with colleagues from a wide range of disciplines while addressing issues that are of importance to our nation.  This year I was fortunate to have been appointed to the NAM Culture of Health Program Advisory Committee and received a copy of the Academies’ intriguing 2017 report Communities in action: Pathways to health equity.  Coming from a psychology-legal orientation, there are elements of their report that I would enthusiastically endorse; and not surprisingly, there are perspectives expressed which with which I am admittedly less comfortable.  Highlights:

            “Health equity is the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance.  Health equity and opportunity are inextricably linked.  Currently in the United States, the burdens of disease and poor health and the benefits of well-being and good health are inequitably distributed.  This inequitable distribution is caused by social, environmental, economic, and structural factors that shape health and are themselves distributed unequally, with pronounced differences in opportunities for health.”

            The report notes that health equity is fundamental to a good life and a vibrant society due to its practical, economic, and civic implications.  Further, health inequity is very costly.  It is estimated that eliminating health disparities for minorities would have resulted in reduced direct medical care costs by nearly $230 billion for the years 2003-2006.  From a national security perspective, nearly one third (32 percent) of all young people experience health problems – other than their weight – that would keep them from serving in the military.  Infant mortality, age-adjusted death rates, and life expectancy are considered critical to judging the overall health of a population.  In international rankings, the U.S. ranks lower than other wealthy nations on each of these indicators – while spending considerably more.

            The Academies’ report identified nine social determinants of health: education, employment, health systems and services, housing, income and wealth, physical environment, public safety, social environment, and transportation.  “Based on its review of the evidence, the committee concludes that health inequities are the result of more than individual choice or random occurrence.  They are the result of the historic and ongoing interplay of inequitable structures, policies, and norms that shape lives.”  And, “In the committee’s judgment, civil rights approaches have helped mitigate the negative impacts of many forms of social and health discrimination.  Continuing this work is needed to overcome discrimination and the structural barriers that affect health.”

            Where I do have a different perspective from that of the committee on achievable priorities relates to their conclusion: “For many years researchers, public health practitioners, and others have known that health status in this country and around the world is determined as much by socioeconomic as biologic or behavioral factors.  Despite that recognition, approaches to improving health status and health outcomes have narrowly centered on improving medical interventions, technologies, systems, and access.  Beyond clinical approaches, some health promotion strategies have focused on changing behavior, despite the robust evidence indicating that they are ineffective in addressing health inequities.  Although these strategies play a role in improving population health, it has become amply clear that they are necessary but not sufficient.  Health is the result of much more than health care; the social, economic, environmental and structural factors – for example, education, poverty, housing, and structural racism – that shape health outcomes also create health inequities.  Addressing and putting an end to health inequities will only be possible if society and decision makers broaden their view of health to fully grasp how steep and unjust disparities in social and other conditions limit, thwart, and even destroy some people’s ability to live healthy and full lives.”  From my perspective, the committee did not go far enough in recognizing and reaching out to psychology and a number of other disciplines which can, and shall, contribute significantly to this important dialogue.

            Interprofessional Collaboration:  Ken Pope recently shared with us a John Hopkins Bloomberg School of Public Health comparison of the quality of physician, Nurse Practitioner (NP), and Physician Assistant (PA) prescribing protocols, covering over 700,000 patient visits.  They examined 13 quality indicators across a range of chronic diseases, including antibiotic use and concurrent prescription of contraindicated medications.  The conclusion: the quality of prescribing was similar across the board and while there was room for improvement in all of their indicators, no one discipline was more likely than another to be nonadherent with guidelines.  NPs and PAs continue to be one solution to physician shortages, with data such as this providing support for their growing autonomy and prescriptive authority.

            “Over the past few years, the Psychiatric Mental Health Nurse Practitioner Doctor of Nursing Practice (DNP) program and the Psychology program at the Uniformed Services University (USU) have increasingly engaged in interprofessional education activities.  Our first effort was our joint Health Policy class exposing graduate students from both disciplines to a wide range of accomplished speakers describing their personal journeys.  These included APA’s Heather Kelly and Steve Behnke; former APA Presidents Ron Fox, Barry Anton, and Don Bersoff; current and former Surgeon Generals and VA Secretaries; as well as a former Prisoner of War.  Dialogue between our disciplines increased and psychology faculty began assisting with topics in the GSN Therapeutic Modalities course, including presentations on cognitive behavioral therapy and biofeedback.  Psychology faculty and graduate students have helped supervise DNP students at the university’s simulation center.  Students from both programs train together and are placed in joint teams at Operation Bushmaster, a large scale simulated operational field training exercise, where they see simulated mental health patients, perform a mock unit needs assessment, and assist with operational stress control.  Psychology students are invited to participate in our Wilderness Medicine field experiences.  Most recently, GSN faculty were selected to teach in the psychopharmacology course for clinical psychology students.  We are now working to start a joint psychotropic interest group, which will involve case-based presentations, and to collaborate on leadership development” [CDR Eric Pauli, USN, NC].

            “I am thrilled to see that the APA Committee, formed to review the Clinical Psychopharmacology Curriculum for prescribing psychology trainees, has recommended that the didactic training can be done at the graduate, predoctoral level.  Certainly, our Illinois graduate students are thrilled with the opportunity to do their training in Clinical Psychopharmacology, as a joint Master’s degree, alongside their doctorate in Psychology.  It is most satisfying that our profession continues to move forward, striving to meet the needs of our psychology students as well as the needs of our larger community” [Beth Rom-Rymer, APA Board of Directors, Council Leadership Team].  In enacting the 2014 Illinois Psychological Association RxP legislation, Beth and her colleagues worked tirelessly in developing a broad based, interprofessional coalition enthusiastically supporting their bill on behalf of the entire community.  [Father Damien].  Aloha,

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

 

EXCITING CHALLENGES FOR THE NEXT GENERATION

             Psychopharmacology (RxP):  In response to the steadily growing interest in psychopharmacology among our profession's next generation of leaders, and especially those students currently in graduate school, APA is seeking public comment on the proposed modifications to the 2009 RxP model Curriculum, model Designation Criteria, and model Legislation pursuant to a Task Force recommendation.  The Task Force was chaired by Ronald Brown.  It had been approved and subsequently convened by BEA, BPA, and CAPP in 2017, holding an-in person meeting at the end of that year.  Their 2018 recommendations, if approved as APA policy, would make clear that it would be appropriate to provide the didactic portion of the psychopharmacology training during graduate school.  Of historical interest, in 1997 APAGS adopted a formal resolution of support for RxP.

            This year the American Psychological Foundation (APF) issued a call for submissions for the Beth Rom-Rymer Scholarship program which will provide up to nine scholarships to support both graduate students and practicing licensed psychologists to complete their RxP training.  This is in addition to the APF Walter Katkovsky research grants supporting research on the general topic of combining psychotherapy and psychoactive medications, where the medication is an adjunct to psychotherapy and not the primary intervention.  Nearly 30 applications were received for Beth's award, clearly reflecting growing enthusiasm for RxP which her efforts, and especially the successful Illinois legislation, have generated within the field.  We would be pleased to learn of interprofessional efforts conducted by State Associations and individual psychologists integrating the expertise of our colleagues in nursing and clinical pharmacy in the training of our next generation.  As a profession, we seem to under-appreciate the significance of the fact that those seeking mental and behavioral health care remain the same individual, regardless of which professional discipline they ultimately chose to work with.  Remaining in isolated professional silos would seem to be counterproductive at best.

The Exciting Advent of Telehealth:  With the ever increasing sophistication occurring within the communications field and the steadily declining cost of the technology, not to mention the ease with which the younger generation relates to this development, there can be little doubt that the future of health care will become increasingly reliant upon its utilization.  The Departments of Veterans Affairs and Defense have been on the cutting edge of utilizing telehealth (e.g., telepsychology) and have had outstanding results, with mental health being a major focus.  Colleagues report that their younger clients often prefer utilizing this technology to in-person encounters.  The quality of care appears to be equivalent.  For those in the private sector, licensure mobility is a major issue which must be addressed.  Under the visionary leadership of Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB), the APA Council of Representatives endorsed in principle their Psychology Interjurisdictional Compact (PSYPACT), a joint initiative with APA and The Trust, during our Denver convention.  The proposed "E-Passport" would allow the provision of psychological services by qualified licensed psychologists via electronic means across jurisdictional boundaries, without additional licensure in the jurisdiction in which the client was physically present when receiving services.  Three states have already endorsed the Compact with similar efforts underway within the Advanced Practice Nursing (APRN) community.  Steve reports that at least seven states must affirmatively enact the Compact legislation in order for psychology to establish a meaningful presence in this new and evolving environment.  Is your State Association affirmatively addressing this critical issue?  Aloha,

Pat DeLeon, former APA President – Division 31 – March, 2018

 

Sent from my iPhone

ALOHA - Div 31

EXCITING CHALLENGES FOR THE NEXT GENERATION

            Psychopharmacology (RxP):  In response to the steadily growing interest in psychopharmacology among our profession’s next generation of leaders, and especially those students currently in graduate school, APA is seeking public comment on the proposed modifications to the 2009 RxP model Curriculum, model Designation Criteria, and model Legislation pursuant to a Task Force recommendation.  The Task Force was chaired by Ronald Brown.  It had been approved and subsequently convened by BEA, BPA, and CAPP in 2017, holding an-in person meeting at the end of that year.  Their 2018 recommendations, if approved as APA policy, would make clear that it would be appropriate to provide the didactic portion of the psychopharmacology training during graduate school.  Of historical interest, in 1997 APAGS adopted a formal resolution of support for RxP.

            This year the American Psychological Foundation (APF) issued a call for submissions for the Beth Rom-Rymer Scholarship program which will provide up to nine scholarships to support both graduate students and practicing licensed psychologists to complete their RxP training.  This is in addition to the APF Walter Katkovsky research grants supporting research on the general topic of combining psychotherapy and psychoactive medications, where the medication is an adjunct to psychotherapy and not the primary intervention.  Nearly 30 applications were received for Beth’s award, clearly reflecting growing enthusiasm for RxP which her efforts, and especially the successful Illinois legislation, have generated within the field.  We would be pleased to learn of interprofessional efforts conducted by State Associations and individual psychologists integrating the expertise of our colleagues in nursing and clinical pharmacy in the training of our next generation.  As a profession, we seem to under-appreciate the significance of the fact that those seeking mental and behavioral health care remain the same individual, regardless of which professional discipline they ultimately chose to work with.  Remaining in isolated professional silos would seem to be counterproductive at best.

The Exciting Advent of Telehealth:  With the ever increasing sophistication occurring within the communications field and the steadily declining cost of the technology, not to mention the ease with which the younger generation relates to this development, there can be little doubt that the future of health care will become increasingly reliant upon its utilization.  The Departments of Veterans Affairs and Defense have been on the cutting edge of utilizing telehealth (e.g., telepsychology) and have had outstanding results, with mental health being a major focus.  Colleagues report that their younger clients often prefer utilizing this technology to in-person encounters.  The quality of care appears to be equivalent.  For those in the private sector, licensure mobility is a major issue which must be addressed.  Under the visionary leadership of Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB), the APA Council of Representatives endorsed in principle their Psychology Interjurisdictional Compact (PSYPACT), a joint initiative with APA and The Trust, during our Denver convention.  The proposed “E-Passport” would allow the provision of psychological services by qualified licensed psychologists via electronic means across jurisdictional boundaries, without additional licensure in the jurisdiction in which the client was physically present when receiving services.  Three states have already endorsed the Compact with similar efforts underway within the Advanced Practice Nursing (APRN) community.  Steve reports that at least seven states must affirmatively enact the Compact legislation in order for psychology to establish a meaningful presence in this new and evolving environment.  Is your State Association affirmatively addressing this critical issue?  Aloha,

Pat DeLeon, former APA President – Division 31 – March, 2018

 

IT IS MY TIME TO GIVE BACK, SINCE SO MANY HAVE GIVEN TO ME

In November 1984, at the Hawaii Psychological Association (HPA) annual convention, U.S. Senator Daniel K. Inouye urged the membership to seek prescriptive authority (RxP): "When you have obtained this statutory authority… you will be an autonomous profession and your clients will be well-served."  In 1990, the APA Council of Representatives established its Task Force on Prescriptive Authority, chaired by Michael Smyer, and on which APA Past President Tony Puente served.  The task force concluded: "practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge.  The contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment."

Having grown up in Connecticut, I admire CPA's renewed efforts to obtain this clinical responsibility, under the leadership of former CPA President and RxP committee chair Barbara Bunk.  Connecticut has an impressive history of providing visionary leadership for the profession, with Alan Kazdin, Bob Sternberg, and the late Neal Miller serving as APA Presidents.  Arthur Evans, APA's new CEO, and Dan Abrahamson, the driving force behind APA's extraordinary state level accomplishments, lived in the Nutmeg State for many years.  Ken Pope and Jeff Zimmerman are dedicated to insuring that our profession becomes aware of the clinical and policy developments occurring within other professions.  Academic and scientific colleagues across the nation have been blessed by the successes of Danbury's Alan Kraut who served as the first Executive Director of the Association for Psychological Science, and currently is Executive Director of the Psychological Clinical Science Accreditation System.

A major lesson learned from the initial RxP successes of Elaine LeVine (New Mexico) and James Quillin (Louisiana) is the importance of developing board-based grassroots support, especially from potential concerned beneficiaries.  We are convinced that psychology will only achieve parity within the nation's healthcare environment by focusing upon society's real needs, and not overly concerning ourselves with "professional turf" issues.  As your initial efforts under Michael Schwarzchild's leadership clearly demonstrated, RxP is fundamentally about increasing access to qualityhealthcare for those most in need.

            Give an Hour:  In our judgment, an exemplary example of "giving psychology away" has been the visionary efforts of Barbara Van Dahlen in establishing Give an Hour.  To date, she and her colleagues have provided more than 124,000 hours of free mental and behavioral health care, valued at over $24 million, through volunteer mental health professionals, for active duty military personnel, Veterans, and their families.  Recently, she has expanded her efforts to address the needs of those impacted by last year's extraordinary series of natural and man-made disasters, including Hurricane Harvey, as well as assisting other special populations who clearly are in need – including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.

            "Building on the tremendous success of the first Global Summit on Mental Health Culture Change held in Los Angeles, California in May, 2017, Give an Hour – in partnership with the UK Ministery of Defense, the Royal Foundation and Combat Stress – brings this exciting gathering to London in June, 2018.  The London Summit will continue the work accomplished in California by gathering together key thought leaders, government officials, stakeholders, policy makers and change agents to focus exclusively on addressing culture as a primary barrier to changing the way we think about, talk about and address emotional well-being and mental health so that all in need – including those who serve as well as civilians – are able to receive appropriate treatment and support.

            "Give an Hour, the backbone organization behind the Campaign to Change Direction, has created A Global Summit on Mental Health Culture Change to showcase successful efforts, forge new alliances and create the strategic vision necessary to eradicate the fear, shame and guilt that prevents those who are suffering from receiving the compassionate care they deserve.  Only through culture change will we achieve lasting change.  Last year, we invited APA President Tony Puente to participate in the summit.  I am excited to include several prominent psychologists among the presenters and participants this coming year" (Barbara Van Dahlen).

            Interprofessional Collaboration:  President Obama's landmark Patient Protection and Affordable Care Act (ACA) envisions a transformed healthcareenvironment in which patient-centered, integrated mental health care will be provided by interprofessional teams with an emphasis upon holistic and preventive care, in contrast to today's fee-for-procedure, acute care orientation.  Three years ago, the California Technology Assessment Forum (CTAF) report Integrating Behavioral Health into Primary Care noted: "Despite a long history in the US of treating physical health conditions separately from behavioral health, the two are inextricably linked.  Up to 70% of physician visits are for issues with a behavioral health component.  A similar percentage of adults with behavioral health conditions have one or more physical health issues.  Having a chronic condition is a risk factor for having a behavioral health condition and vice versa.  Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions."  CTAF further noted that anxiety and depression are the most common behavioral health disorders in primary care settings.

            Visionary Initiatives – One Step at a Time:  "From the mid-90s until the internship at Federal Correctional Institution at Petersburg, Virginia was closed in 2001, we had all our interns participate in psychiatry's rounds with the option to do a minor rotation in clinical psychopharmacology.  We created medication information sheets for the inmate-patients.  One of our interns, whose first language was Spanish, created a Spanish-language version which was very helpful.  The first psychiatrist I worked with at the prison was adamantly opposed to giving patients information about meds.  He thought that keeping them ignorant made them more compliant.  Working with him was how I began to support RxP" [Bob Ax].  Linda Campbell who initiated one of psychology's first RxP training programs with her University of Georgia pharmacy colleagues: "A colleague and I have developed an integrated free clinic in Athens.  We are growing a training program for pharmacy and psychology students working shoulder to shoulder in achieving incredible health outcomes for low SES rural populations.  I have worked closely with the College of Pharmacy since our initial efforts and it has paid off."

Last year APA convened a Task Force to review, and where appropriate, update the criteria for the curriculum for APA designated RxP training programs.  Their report is out for public comment and expected to be submitted to Council this year.  Those interested in providing didactic training at the graduate level will be pleased.  As Tony Puente and Fernanda De Oliveira have noted, many Early Career Psychologists interested in pursuing this clinical responsibility will no longer have to "start from scratch" and wonder if, during their already extensive training, they had obtained a sufficient foundation to pursue RxP.  Hopefully, increasing opportunities for interprofessional psychopharmacology training will also evolve.  [Tony Puente].  Aloha,

Pat DeLeon, former APA President – CPA – February, 2018

 

Sent from my iPhone

ALOHA - CPA column

“IT IS MY TIME TO GIVE BACK, SINCE SO MANY HAVE GIVEN TO ME”

In November 1984, at the Hawaii Psychological Association (HPA) annual convention, U.S. Senator Daniel K. Inouye urged the membership to seek prescriptive authority (RxP): “When you have obtained this statutory authority… you will be an autonomous profession and your clients will be well-served.”  In 1990, the APA Council of Representatives established its Task Force on Prescriptive Authority, chaired by Michael Smyer, and on which APA Past President Tony Puente served.  The task force concluded: “practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge.  The contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment.”

Having grown up in Connecticut, I admire CPA’s renewed efforts to obtain this clinical responsibility, under the leadership of former CPA President and RxP committee chair Barbara Bunk.  Connecticut has an impressive history of providing visionary leadership for the profession, with Alan Kazdin, Bob Sternberg, and the late Neal Miller serving as APA Presidents.  Arthur Evans, APA’s new CEO, and Dan Abrahamson, the driving force behind APA’s extraordinary state level accomplishments, lived in the Nutmeg State for many years.  Ken Pope and Jeff Zimmerman are dedicated to insuring that our profession becomes aware of the clinical and policy developments occurring within other professions.  Academic and scientific colleagues across the nation have been blessed by the successes of Danbury’s Alan Kraut who served as the first Executive Director of the Association for Psychological Science, and currently is Executive Director of the Psychological Clinical Science Accreditation System.

A major lesson learned from the initial RxP successes of Elaine LeVine (New Mexico) and James Quillin (Louisiana) is the importance of developing board-based grassroots support, especially from potential concerned beneficiaries.  We are convinced that psychology will only achieve parity within the nation’s healthcare environment by focusing upon society’s real needs, and not overly concerning ourselves with “professional turf” issues.  As your initial efforts under Michael Schwarzchild’s leadership clearly demonstrated, RxP is fundamentally about increasing access to quality healthcare for those most in need.

            Give an Hour:  In our judgment, an exemplary example of “giving psychology away” has been the visionary efforts of Barbara Van Dahlen in establishing Give an Hour.  To date, she and her colleagues have provided more than 124,000 hours of free mental and behavioral health care, valued at over $24 million, through volunteer mental health professionals, for active duty military personnel, Veterans, and their families.  Recently, she has expanded her efforts to address the needs of those impacted by last year’s extraordinary series of natural and man-made disasters, including Hurricane Harvey, as well as assisting other special populations who clearly are in need – including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.

            “Building on the tremendous success of the first Global Summit on Mental Health Culture Change held in Los Angeles, California in May, 2017, Give an Hour – in partnership with the UK Ministery of Defense, the Royal Foundation and Combat Stress – brings this exciting gathering to London in June, 2018.  The London Summit will continue the work accomplished in California by gathering together key thought leaders, government officials, stakeholders, policy makers and change agents to focus exclusively on addressing culture as a primary barrier to changing the way we think about, talk about and address emotional well-being and mental health so that all in need – including those who serve as well as civilians – are able to receive appropriate treatment and support.

            “Give an Hour, the backbone organization behind the Campaign to Change Direction, has created A Global Summit on Mental Health Culture Change to showcase successful efforts, forge new alliances and create the strategic vision necessary to eradicate the fear, shame and guilt that prevents those who are suffering from receiving the compassionate care they deserve.  Only through culture change will we achieve lasting change.  Last year, we invited APA President Tony Puente to participate in the summit.  I am excited to include several prominent psychologists among the presenters and participants this coming year” (Barbara Van Dahlen).

            Interprofessional Collaboration:  President Obama’s landmark Patient Protection and Affordable Care Act (ACA) envisions a transformed healthcare environment in which patient-centered, integrated mental health care will be provided by interprofessional teams with an emphasis upon holistic and preventive care, in contrast to today’s fee-for-procedure, acute care orientation.  Three years ago, the California Technology Assessment Forum (CTAF) report Integrating Behavioral Health into Primary Care noted: “Despite a long history in the US of treating physical health conditions separately from behavioral health, the two are inextricably linked.  Up to 70% of physician visits are for issues with a behavioral health component.  A similar percentage of adults with behavioral health conditions have one or more physical health issues.  Having a chronic condition is a risk factor for having a behavioral health condition and vice versa.  Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions.”  CTAF further noted that anxiety and depression are the most common behavioral health disorders in primary care settings.

            Visionary Initiatives – One Step at a Time:  “From the mid-90s until the internship at Federal Correctional Institution at Petersburg, Virginia was closed in 2001, we had all our interns participate in psychiatry’s rounds with the option to do a minor rotation in clinical psychopharmacology.  We created medication information sheets for the inmate-patients.  One of our interns, whose first language was Spanish, created a Spanish-language version which was very helpful.  The first psychiatrist I worked with at the prison was adamantly opposed to giving patients information about meds.  He thought that keeping them ignorant made them more compliant.  Working with him was how I began to support RxP” [Bob Ax].  Linda Campbell who initiated one of psychology’s first RxP training programs with her University of Georgia pharmacy colleagues: “A colleague and I have developed an integrated free clinic in Athens.  We are growing a training program for pharmacy and psychology students working shoulder to shoulder in achieving incredible health outcomes for low SES rural populations.  I have worked closely with the College of Pharmacy since our initial efforts and it has paid off.”

Last year APA convened a Task Force to review, and where appropriate, update the criteria for the curriculum for APA designated RxP training programs.  Their report is out for public comment and expected to be submitted to Council this year.  Those interested in providing didactic training at the graduate level will be pleased.  As Tony Puente and Fernanda De Oliveira have noted, many Early Career Psychologists interested in pursuing this clinical responsibility will no longer have to “start from scratch” and wonder if, during their already extensive training, they had obtained a sufficient foundation to pursue RxP.  Hopefully, increasing opportunities for interprofessional psychopharmacology training will also evolve.  [Tony Puente].  Aloha,

Pat DeLeon, former APA President – CPA – February, 2018