Division 18 column -- ALOHA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MEMORIES ARE MADE FROM THIS

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

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

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

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

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

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

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

ALOHA

“MEMORIES ARE MADE FROM THIS”

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

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

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

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

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

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

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

LEAVING ON A JET PLANE

Interprofessional Collaboration: One of the underlying tenets of President Obama's Patient Protection and Affordable Care Act (ACA) is the provision of patient-centered holistic care, provided by interdisciplinary teams of health professionals. Psychology and nursing have a long, if not well appreciated, history of collaborative efforts. Carol Goodheart, APA 2010 President, has a nursing background; as does Linda Richardson, former President of Division 18 (Psychologists in Public Service). Beverly Malone, CEO of the National League for Nursing, and Nursing "Living Legend" Angelia McBride both possess doctoral degrees in psychology. Susan McDaniel, 2016 APA President noted: "The primary care workforce now depends on Nurse Practitioners (NPs) and nurses to provide high quality primary care."

Accordingly, when on February 4, 2019, New Mexico Governor Michelle Lujan Grisham signed into public law a significant modification of their landmark 2002 Prescriptive Authority legislation, we were very pleased that our ground-breaking colleagues involved professional nursing. The new provisions authorized New Mexico psychiatric nurse practitioners (as well as clinical nurse specialists and other nurse practitioner specialties) to serve as supervisors and collaborative partners during the required practicum supervision and conditional authority process.

"New Mexico's psychologists, and particularly prescribing psychologists, have always maintained a highly respectful and productive relationship with our nursing colleagues. Our close working relationship with nurses has greatly enhanced quality care to many underserved populations in the state. Academic nurses from New Mexico State University (NMSU) were instrumental in developing the pathophysiology and physical assessment modules of the University's post-doctoral master's degree in clinical psychopharmacology. They testified for psychologists on behalf of our RxP bill and have taught in the NMSU post-doctoral program, as well as providing some ongoing continuing education training for our prescribing psychologists. We are pleased to be expanding our collaborative efforts. Nurse practitioners provide a preponderance of care in underserved communities in New Mexico. With our appended law, which will allow nurses to supervise our RxP students in training, we will be able to extend access and quality care across New Mexico" (Renee Wilkins and Elaine Levine). Following New Mexico's lead, psychology prescribing bills in the Hawaii and Florida legislature this year will also formally recognize nursing's clinical expertise.

Advancing the RxP Movement: Hawaii's Judi Steinman, Division 55 President: "We have included Nurse Practitioners and Prescribing Psychologists as practicum supervisors in our Hawaii RxP bills, recognizing the skills and expertise of these specialties as educators as well as practicum preceptors. Some of our islands do not even have physicians, let alone psychiatrists, willing to serve as supervisors. The University of Hawaii at Hilo and now Alliant International University MSCP programs include APRNs-Rx's as faculty members." Steve and Anthony Ragusea: "Florida prescribing psychologists would welcome nurse practitioner supervision as one of several options and we hope that the Florida legislature will permit us to follow New Mexico's visionary lead in this regard."

The Duke Blue Devils: Two of the former faculty members of the Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University (USU), U. S. Navy Commanders (ret.) Sean Convoy and Pam Wall have been developing the psychiatric mental health nurse practitioner program at Duke University, emphasizing on-line education. Both Sean and Pam served in the Navy for over two decades. Sean: "We are hoping this effort reflects a new entrepreneurial spirit defined by genuine inter-professional collaboration that places patient access and outcomes above provider pedigree and earning potential. Supported by the Institute of Medicine's Future of Nursing report, the Federal Trade Commission's report on Competition and the Regulation of Advanced Practice Registered Nurses (APRNs), and the seven states and territories that have passed legislation supporting prescriptive authority for clinical psychologists, we are constructing a strong foundation for a long overdue paradigm change. APRNs providing prescriptive supervision to clinical psychologists represents scaffolding for this new paradigm. We would like to see a more balanced approach where APRNs collaborate with clinical psychologists to translate their psychotropic prescribing knowledge, skills and abilities (KSA) and our clinical psychologist brethren translate their advanced psychotherapeutic KSA back to APRNs. In a new paradigm such as this, all members of the mental health care delivery system would be vital and valued members of an ensemble cast where the diversity of our education and experience are seen as strengths and not wedge issues.

"At Duke University's School of Nursing we are currently partnering with all willing stakeholders to grow our psychiatric mental health nurse practitioner program. We partner with our physician and clinical psychology colleagues for preceptorship support, standardized patient simulation and most recently a local DukeAhead grant entitled 'Training and Education to Advance Multicultural Mental Healthcare Delivery (TEAM Mental Healthcare Delivery)'. Much like the larger political discourse we currently live in, the public has grown weary of political infighting. Now is the time for members of the mental health care delivery system to genuinely collaborate, strike grand bargains and reestablish that shared mental health vision which recognizes the patient as the chief outcome of a shared interest." In appreciation for their collaboration, Susan McDaniel served on the Duke University School of Nursing Board of Advisors for six years.

Telehealth – The Wave of the Future: "As the Program Manager for the Military Health System Virtual Health Program, I can appreciate the importance of psychology and nursing developing an increasing presence in telehealth. The National Defense Authorization Acts of 2017 and 2019 gave us a path to work together as a team of healthcare providers supporting Soldiers, Sailors, Marines, and Airmen to achieve a high level of Readiness while maintaining the health of Military Beneficiaries. For this reason, the legislation centralized the delivery of healthcare within the Military Treatment Facilities around the world that support military health beneficiaries with the intent of making the Quadruple AIM goals (i.e., improving the health of populations, enhancing the experience of receiving care, reducing the per capita cost; and, for the military, enhancing Readiness) a reality. Virtual health, as a modality to deliver healthcare, provides our beneficiaries medical care through mobile technologies, anytime and anywhere, while enhancing the availability of specialty services.

"Three main capabilities are being pursued within the Military Health System which includes Synchronous, Asynchronous and Remote Health Monitoring care. Synchronous capabilities allow beneficiaries to perform live interactions with members of the healthcare team. Asynchronous capabilities provide a direct provider to provider teleconsultation portal that enhances the ability of primary care providers to get near immediate access to specialists in any environment, including areas that have limited or sporadic bandwidth. Finally, remote health monitoring allows for the direct visualization of healthcare status of chronically ill patients, allowing us to inject a dose of healthcare within the patient's home environment. Virtual health technology will allow us to improve the 'lethality' of the Military Health System (from a healthcare perspective) by enabling methods to improve Readiness while enhancing the availability of Military Medical Services around the world, while reducing costs, enhancing access and improving quality" (U. S. Army Col. Francisco Dominicci).

A Recurring Question: Are psychology's graduate training programs preparing the next generation of clinicians to practice successfully within the health care environment of the future? To date, I have not been able to identify any psychology graduate program that provides its students with telehealth training experiences. In contrast, at USU Jeff Goodie actively collaborates with the Family Medicine department and Nursing programs to have graduate psychology students engage with their medical and nursing colleagues. "We have our advanced clinical psychology students observe Family Medicine clerkship students during an interview with standardized patients and then give structured feedback to those medical students about their communication skills. Psychology students also practice providing behavioral health interventions alongside Psychiatric Mental Health Nurse Practitioner students during a three day deployment exercise."

APA recognizes the importance of promoting interprofessional training. As APA President Susan, with support from APA staff Catherine Grus, appointed Jeff and Ron Rozensky co-chairs of a work group that created an Interprofessional Seminar on Integrated Primary Care [https://www.apa.org/education/grad/curriculum-seminar] that is a resource for helping healthcare professionals develop competencies for working together. The seminar includes modules that can be adapted as needed to cover a range of topics including elements of interprofessional care, ethics, models of leadership, and health policy and advocacy. "Don't know when I'll be back again" (John Denver). Aloha,

Pat DeLeon, former APA President – Hawaii Psychological Association – March, 2019

ALOHA -- HPA column

“LEAVING ON A JET PLANE”

            Interprofessional Collaboration:  One of the underlying tenets of President Obama’s Patient Protection and Affordable Care Act (ACA) is the provision of patient-centered holistic care, provided by interdisciplinary teams of health professionals.  Psychology and nursing have a long, if not well appreciated, history of collaborative efforts.  Carol Goodheart, APA 2010 President, has a nursing background; as does Linda Richardson, former President of Division 18 (Psychologists in Public Service).  Beverly Malone, CEO of the National League for Nursing, and Nursing “Living Legend” Angelia McBride both possess doctoral degrees in psychology.  Susan McDaniel, 2016 APA President noted: “The primary care workforce now depends on Nurse Practitioners (NPs) and nurses to provide high quality primary care.”

Accordingly, when on February 4, 2019, New Mexico Governor Michelle Lujan Grisham signed into public law a significant modification of their landmark 2002 Prescriptive Authority legislation, we were very pleased that our ground-breaking colleagues involved professional nursing.  The new provisions authorized New Mexico psychiatric nurse practitioners (as well as clinical nurse specialists and other nurse practitioner specialties) to serve as supervisors and collaborative partners during the required practicum supervision and conditional authority process.

“New Mexico’s psychologists, and particularly prescribing psychologists, have always maintained a highly respectful and productive relationship with our nursing colleagues.  Our close working relationship with nurses has greatly enhanced quality care to many underserved populations in the state.  Academic nurses from New Mexico State University (NMSU) were instrumental in developing the pathophysiology and physical assessment modules of the University’s post-doctoral master’s degree in clinical psychopharmacology.  They testified for psychologists on behalf of our RxP bill and have taught in the NMSU post-doctoral program, as well as providing some ongoing continuing education training for our prescribing psychologists.  We are pleased to be expanding our collaborative efforts.  Nurse practitioners provide a preponderance of care in underserved communities in New Mexico.  With our appended law, which will allow nurses to supervise our RxP students in training, we will be able to extend access and quality care across New Mexico” (Renee Wilkins and Elaine Levine).  Following New Mexico’s lead, psychology prescribing bills in the Hawaii and Florida legislature this year will also formally recognize nursing’s clinical expertise.

            Advancing the RxP Movement:  Hawaii’s Judi Steinman, Division 55 President: “We have included Nurse Practitioners and Prescribing Psychologists as practicum supervisors in our Hawaii RxP bills, recognizing the skills and expertise of these specialties as educators as well as practicum preceptors.  Some of our islands do not even have physicians, let alone psychiatrists, willing to serve as supervisors.  The University of Hawaii at Hilo and now Alliant International University MSCP programs include APRNs-Rx’s as faculty members.”  Steve and Anthony Ragusea: “Florida prescribing psychologists would welcome nurse practitioner supervision as one of several options and we hope that the Florida legislature will permit us to follow New Mexico’s visionary lead in this regard.”

            The Duke Blue Devils:  Two of the former faculty members of the Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University (USU), U. S. Navy Commanders (ret.) Sean Convoy and Pam Wall have been developing the psychiatric mental health nurse practitioner program at Duke University, emphasizing on-line education.  Both Sean and Pam served in the Navy for over two decades.  Sean: “We are hoping this effort reflects a new entrepreneurial spirit defined by genuine inter-professional collaboration that places patient access and outcomes above provider pedigree and earning potential.  Supported by the Institute of Medicine’s Future of Nursing report, the Federal Trade Commission’s report on Competition and the Regulation of Advanced Practice Registered Nurses (APRNs), and the seven states and territories that have passed legislation supporting prescriptive authority for clinical psychologists, we are constructing a strong foundation for a long overdue paradigm change.  APRNs providing prescriptive supervision to clinical psychologists represents scaffolding for this new paradigm.  We would like to see a more balanced approach where APRNs collaborate with clinical psychologists to translate their psychotropic prescribing knowledge, skills and abilities (KSA) and our clinical psychologist brethren translate their advanced psychotherapeutic KSA back to APRNs.  In a new paradigm such as this, all members of the mental health care delivery system would be vital and valued members of an ensemble cast where the diversity of our education and experience are seen as strengths and not wedge issues.

            “At Duke University’s School of Nursing we are currently partnering with all willing stakeholders to grow our psychiatric mental health nurse practitioner program.  We partner with our physician and clinical psychology colleagues for preceptorship support, standardized patient simulation and most recently a local DukeAhead grant entitled ‘Training and Education to Advance Multicultural Mental Healthcare Delivery (TEAM Mental Healthcare Delivery)’.  Much like the larger political discourse we currently live in, the public has grown weary of political infighting.  Now is the time for members of the mental health care delivery system to genuinely collaborate, strike grand bargains and reestablish that shared mental health vision which recognizes the patient as the chief outcome of a shared interest.”  In appreciation for their collaboration, Susan McDaniel served on the Duke University School of Nursing Board of Advisors for six years.

            Telehealth – The Wave of the Future:  “As the Program Manager for the Military Health System Virtual Health Program, I can appreciate the importance of psychology and nursing developing an increasing presence in telehealth.  The National Defense Authorization Acts of 2017 and 2019 gave us a path to work together as a team of healthcare providers supporting Soldiers, Sailors, Marines, and Airmen to achieve a high level of Readiness while maintaining the health of Military Beneficiaries.  For this reason, the legislation centralized the delivery of healthcare within the Military Treatment Facilities around the world that support military health beneficiaries with the intent of making the Quadruple AIM goals (i.e., improving the health of populations, enhancing the experience of receiving care, reducing the per capita cost; and, for the military, enhancing Readiness) a reality.  Virtual health, as a modality to deliver healthcare, provides our beneficiaries medical care through mobile technologies, anytime and anywhere, while enhancing the availability of specialty services.

            “Three main capabilities are being pursued within the Military Health System which includes Synchronous, Asynchronous and Remote Health Monitoring care.  Synchronous capabilities allow beneficiaries to perform live interactions with members of the healthcare team.  Asynchronous capabilities provide a direct provider to provider teleconsultation portal that enhances the ability of primary care providers to get near immediate access to specialists in any environment, including areas that have limited or sporadic bandwidth.  Finally, remote health monitoring allows for the direct visualization of healthcare status of chronically ill patients, allowing us to inject a dose of healthcare within the patient’s home environment.  Virtual health technology will allow us to improve the ‘lethality’ of the Military Health System (from a healthcare perspective) by enabling methods to improve Readiness while enhancing the availability of Military Medical Services around the world, while reducing costs, enhancing access and improving quality” (U. S. Army Col. Francisco Dominicci).

A Recurring Question:  Are psychology’s graduate training programs preparing the next generation of clinicians to practice successfully within the health care environment of the future?  To date, I have not been able to identify any psychology graduate program that provides its students with telehealth training experiences.  In contrast, at USU Jeff Goodie actively collaborates with the Family Medicine department and Nursing programs to have graduate psychology students engage with their medical and nursing colleagues.  “We have our advanced clinical psychology students observe Family Medicine clerkship students during an interview with standardized patients and then give structured feedback to those medical students about their communication skills.  Psychology students also practice providing behavioral health interventions alongside Psychiatric Mental Health Nurse Practitioner students during a three day deployment exercise.”

APA recognizes the importance of promoting interprofessional training.  As APA President Susan, with support from APA staff Catherine Grus, appointed Jeff and Ron Rozensky co-chairs of a work group that created an Interprofessional Seminar on Integrated Primary Care [https://www.apa.org/education/grad/curriculum-seminar] that is a resource for helping healthcare professionals develop competencies for working together.  The seminar includes modules that can be adapted as needed to cover a range of topics including elements of interprofessional care, ethics, models of leadership, and health policy and advocacy.  “Don’t know when I’ll be back again” (John Denver).   Aloha,

Pat DeLeon, former APA President – Hawaii Psychological Association – March, 2019

IF IT WASN’T FOR THE LIGHTHOUSE

With substantive change comes exciting opportunities and admittedly challenges. Tony Puente has just completed his term on the Board of Directors, having served as APA's 125th President in 2017. "The beginning of a new era for APA started this year with the development of a new focus on advocacy. APA has over the last 126 years been devoted to PSYCHOLOGY. More recently, the focus on PSYCHOLOGISTS emerged from the increasing and critical need to make advocacy core to APA. The practice community, with the advent of the APA Practice Organization under the direction of Bryant Welch, had started the focus in the late 1980s. Issues such as scope of practice, physician definition, and reimbursement were attended by a devoted and outstanding staff and the effort was guided by the Committee for the Advancement of Professional Practice of Psychology (CAPP). The APA Psychological Services, Inc. took over this function but, in addition, integrated all four silos at APA – Education, Practice, Public Interest, and Science, as well as developed a sustainable revenue stream (60% of membership dues). This new entity is being directed by the newly hired Katherine McGuire who has an extensive and respected advocacy history in working both in Congress and the private sector.

"The APA leadership group guiding this effort is made up of 14 highly qualified members of APA representing all of the association and being led by co-chairs Jennifer Kelly, long time APA Secretary, and myself. This group, known as the Advocacy Coordinating Committee, is the outgrowth of two prior working groups one each in 2017 and 2018. At the present time the group is establishing its working infrastructure; as well as starting to gather data about advocacy needs. A very brief survey to all members and a sample of non-members of APA will be going out early in February. The goal is to gather significant amounts of information in order to develop strategic advocacy plans for the association. This exciting new venture will also increase and consolidate a wide variety of member benefits. Again, the focus of APA Services, Inc. is to better serve the needs of ALL psychologists and for APA to have ONE VOICE representing all of our members in the world of advocacy." Jennifer: "It has been a rewarding and enriching experience to be part of this inaugural group. All the members of the committee have had extensive experience in advocacy, but it has usually been within each respective area. To be able to approach advocacy from an integrated approach and eliminating the silos will serve to make the association and the profession stronger."

Making A Difference: Many of us decided upon a career in psychology because we felt that we could make a real difference in the lives of our fellow citizens, on the individual or systems/societal level. Accordingly, we were particularly pleased with the APA Citizen Psychologist initiative of last year's President Jessica Henderson Daniel, highlighting the many contributions of the often unheralded "best of psychology." Jessica -- APA Citizen Psychologists are defined as individuals who serve as leaders in their various communities. Through prolonged engagement in significant activities, they contribute to improving the lives of all. This can include public service, volunteerism, board membership and other strategic roles often not directly associated with the day-to-day work of psychologists in our careers. APA Citizen Psychologists come from all branches of the field of psychology. They bring psychological science and expertise to bear on existing challenges to improve community well-being locally, nationally, or globally.

Over the years, we have been similarly impressed by the dedication and vision of Barbara Van Dahlen, Founder and President of Give an Hour, and the impact of her organization. Barbara has been formally recognized by APA Presidents Don Bersoff and Melba Vasquez. "In response to the November Borderline mass shooting in Thousand Oaks California, Give an Hour California is proud to be partnering with the Ventura County Community Foundation to support the administration of Conejo Valley Victim's Fund. In addition to assisting those who were present, injured, or lost a loved one in the attack, Give an Hour is also offering pro bono mental health support through our Provider Network, and case management services. We are working with community leaders to build and implement a comprehensive long-term plan to support not only those affected by the Borderline mass shooting, but the entire community as they move from recovery to resilience after the shooting and fires that consumed the area immediately following the shooting.

"We have also opened our network of volunteer mental health professionals to support the more than 12,000 immigrant and refugee children – and their families – who are being affected by the humanitarian crisis at the U.S. Southern border. We are honored to offer critical expertise and support to address the acute and long-term mental health consequences for children and families separated from each other upon entry to the United States. Many of these families were fleeing violence in their countries of origin. Many have already experienced considerable trauma.

"Working to assist government agencies and non-profit organizations responding to this critical need, Give an Hour is collaborating with major mental health associations in this unprecedented effort including the APA, the California Psychological Association, and CAMFT (California Association of Marriage and Family Therapists). We are honored to be working with these fine organizations and are inviting ALL licensed mental health professionals to join us to support families affected by this trauma and others that affect our citizens [www.giveanhour.org]."

Prescriptive Authority: For a number of us involved in the prescription privilege (RxP) agenda, the underlying issue has always been access to the highest possible quality of care. Ever since U.S. Senator Daniel K. Inouye addressed their membership in November, 1984, Hawaii Psychological Association (HPA) has been actively pursuing this legislative agenda, once having gotten as far as the Governor who ultimately vetoed their bill. The essence of their legislative approach has been to actively engage those in the community who would directly benefit. Once again this year, Mental Health America of Hawaii made access to prescriptive authority for advanced trained clinical psychologists a high priority.

Judi Steinman: "Hawai'i legislators introduced three separate bills proposing prescriptive authority for specially trained psychologists. Legislators from every island across the state served as co-introducers of these bills, a first for us in our efforts to address the tsunami of suffering in our underserved communities. Another first is that House and Senate leadership are amongst those who introduced these bills; with the House Vice Speaker, Majority Leader, Majority Floor Leader, and Majority Whips. A new Senator and Majority Caucus Leader and Majority Floor Leader – both from Hawai'i Island – introduced legislation; while the Senate Vice President is warmly supportive. Our champions in both the House and Senate include the Chairs of the respective Health Committees." Meaningful change always takes time and persistence. "Where would this ship be?" [The Oak Ridge Boys]. Aloha,

Pat DeLeon, former APA President – Division One – February, 2019



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ALOHA - Division One column

“IF IT WASN’T FOR THE LIGHTHOUSE”

            With substantive change comes exciting opportunities and admittedly challenges.  Tony Puente has just completed his term on the Board of Directors, having served as APA’s 125^th President in 2017.  “The beginning of a new era for APA started this year with the development of a new focus on advocacy.  APA has over the last 126 years been devoted to PSYCHOLOGY.  More recently, the focus on PSYCHOLOGISTS emerged from the increasing and critical need to make advocacy core to APA.  The practice community, with the advent of the APA Practice Organization under the direction of Bryant Welch, had started the focus in the late 1980s.  Issues such as scope of practice, physician definition, and reimbursement were attended by a devoted and outstanding staff and the effort was guided by the Committee for the Advancement of Professional Practice of Psychology (CAPP).  The APA Psychological Services, Inc. took over this function but, in addition, integrated all four silos at APA – Education, Practice, Public Interest, and Science, as well as developed a sustainable revenue stream (60% of membership dues).  This new entity is being directed by the newly hired Katherine McGuire who has an extensive and respected advocacy history in working both in Congress and the private sector.

“The APA leadership group guiding this effort is made up of 14 highly qualified members of APA representing all of the association and being led by co-chairs Jennifer Kelly, long time APA Secretary, and myself.  This group, known as the Advocacy Coordinating Committee, is the outgrowth of two prior working groups one each in 2017 and 2018.  At the present time the group is establishing its working infrastructure; as well as starting to gather data about advocacy needs.  A very brief survey to all members and a sample of non-members of APA will be going out early in February.  The goal is to gather significant amounts of information in order to develop strategic advocacy plans for the association.  This exciting new venture will also increase and consolidate a wide variety of member benefits.  Again, the focus of APA Services, Inc. is to better serve the needs of ALL psychologists and for APA to have ONE VOICE representing all of our members in the world of advocacy.”  Jennifer: “It has been a rewarding and enriching experience to be part of this inaugural group.  All the members of the committee have had extensive experience in advocacy, but it has usually been within each respective area.  To be able to approach advocacy from an integrated approach and eliminating the silos will serve to make the association and the profession stronger.”

            Making A Difference:  Many of us decided upon a career in psychology because we felt that we could make a real difference in the lives of our fellow citizens, on the individual or systems/societal level.  Accordingly, we were particularly pleased with the APA Citizen Psychologist initiative of last year’s President Jessica Henderson Daniel, highlighting the many contributions of the often unheralded “best of psychology.”  Jessica -- APA Citizen Psychologists are defined as individuals who serve as leaders in their various communities.  Through prolonged engagement in significant activities, they contribute to improving the lives of all.  This can include public service, volunteerism, board membership and other strategic roles often not directly associated with the day-to-day work of psychologists in our careers.  APA Citizen Psychologists come from all branches of the field of psychology.  They bring psychological science and expertise to bear on existing challenges to improve community well-being locally, nationally, or globally.

Over the years, we have been similarly impressed by the dedication and vision of Barbara Van Dahlen, Founder and President of Give an Hour, and the impact of her organization.  Barbara has been formally recognized by APA Presidents Don Bersoff and Melba Vasquez.  “In response to the November Borderline mass shooting in Thousand Oaks California, Give an Hour California is proud to be partnering with the Ventura County Community Foundation to support the administration of Conejo Valley Victim’s Fund.  In addition to assisting those who were present, injured, or lost a loved one in the attack, Give an Hour is also offering pro bono mental health support through our Provider Network, and case management services.  We are working with community leaders to build and implement a comprehensive long-term plan to support not only those affected by the Borderline mass shooting, but the entire community as they move from recovery to resilience after the shooting and fires that consumed the area immediately following the shooting.

            “We have also opened our network of volunteer mental health professionals to support the more than 12,000 immigrant and refugee children – and their families – who are being affected by the humanitarian crisis at the U.S. Southern border.  We are honored to offer critical expertise and support to address the acute and long-term mental health consequences for children and families separated from each other upon entry to the United States.  Many of these families were fleeing violence in their countries of origin.  Many have already experienced considerable trauma.

            “Working to assist government agencies and non-profit organizations responding to this critical need, Give an Hour is collaborating with major mental health associations in this unprecedented effort including the APA, the California Psychological Association, and CAMFT (California Association of Marriage and Family Therapists).  We are honored to be working with these fine organizations and are inviting ALL licensed mental health professionals to join us to support families affected by this trauma and others that affect our citizens [www.giveanhour.org].”

            Prescriptive Authority:  For a number of us involved in the prescription privilege (RxP) agenda, the underlying issue has always been access to the highest possible quality of care.  Ever since U.S. Senator Daniel K. Inouye addressed their membership in November, 1984, Hawaii Psychological Association (HPA) has been actively pursuing this legislative agenda, once having gotten as far as the Governor who ultimately vetoed their bill.  The essence of their legislative approach has been to actively engage those in the community who would directly benefit.  Once again this year, Mental Health America of Hawaii made access to prescriptive authority for advanced trained clinical psychologists a high priority.

            Judi Steinman: “Hawai’i legislators introduced three separate bills proposing prescriptive authority for specially trained psychologists.  Legislators from every island across the state served as co-introducers of these bills, a first for us in our efforts to address the tsunami of suffering in our underserved communities.  Another first is that House and Senate leadership are amongst those who introduced these bills; with the House Vice Speaker, Majority Leader, Majority Floor Leader, and Majority Whips.  A new Senator and Majority Caucus Leader and Majority Floor Leader – both from Hawai’i Island – introduced legislation; while the Senate Vice President is warmly supportive.  Our champions in both the House and Senate include the Chairs of the respective Health Committees.”  Meaningful change always takes time and persistence.   “Where would this ship be?” [The Oak Ridge Boys].  Aloha,

Pat DeLeon, former APA President – Division One – February, 2019