ALOHA - D29

“ROCKIN’ PNEUMONIA”

            Advancing Practice Together:  Just prior to the last winter blast striking our nation’s Capital, I was very fortunate to be able to attend the 35^th annual APAPO Practice Leadership conference, along with former APA Presidents James Bray and Carol Goodheart.  These gatherings are always the highlight of my professional year and it was especially exciting this year to experience the genuine enthusiasm generated by so many first time attendees and APAGS students.  Katherine Nordal will be leaving APA after a decade of service, not to mention serving in a variety of roles, including as an APA Congressional Fellow.  The 350 attendees were constantly expressing their gratitude for all that she had accomplished and her willingness to strategically “disrupt” our thinking so that collectively, we could seek greater heights.  As Katherine would say during the Opening Reception, psychology can make a real difference to so many people and we should appreciate that we do save lives.  It was a particular delight that President Jessica Henderson Daniel presented long-time state association advocate Mike Sullivan with an APA Citizen Psychologist Presidential Citation.  This is a well-deserved tribute.  Dan Abrahamson and Susan Lazaroff did an outstanding job.  The future is bright.

            Integrated-Interprofessional Health Care:  One of the foundations of President Obama’s Patient Protection and Affordable Care Act (ACA) was a visionary emphasis upon fostering team-based interprofessional care, with behavioral health being increasingly integrated into primary care.  Linda Campbell was one of the original architects of a quality psychopharmacology training program for those interested in obtaining prescriptive (RxP) authority.  She worked closely with her pharmacy colleagues at the University of Georgia -- a training model that continues to serve psychology admirably.  Linda’s report on her most recent initiative:  “In 2016, I joined with Dr. Edward Delgado-Romero and Dr. Linda Logan who are faculty at the University of Georgia to begin an integrated behavioral health practicum at Mercy Health Center in Atlanta, Georgia.  Dr. Delgado-Romero and I are counseling psychology faculty members and Dr. Logan is a School of Pharmacy and College of Education faculty member.  Prior to the inception of this integrated training experience, we worked together in the department’s training clinic for 10 years, developing an integrated training model for doctoral and masters students.  The department training clinic includes advanced nursing students from the Augusta School of Nursing.  This program is still growing and is a popular rotation for pharmacy and nursing students.

            “Mercy Health Center is a health care clinic for the underserved populations who have no insurance; no Medicare, Medicaid, or any other means of paying for health care.  Except for a small employee staff, over 70 physicians, dentists, and other medical specialists devote pro bono time to serve the population.  We took our model from the department training clinic to Mercy where we work with Kristi Gilleland, the Whole Person Health Coordinator, and Tracy Thompson, CEO.  Together, we have developed an integrated staffing of pharmacy, social work, legal consultation, nutrition, and specialty medical services.  The training model includes individual behavioral health services, chronic illness groups, and pre- and post-therapy groups to ensure health promoting behaviors are secured before termination.  All patients are rural and low SES (socioeconomic status), but additionally about 30% are Spanish speaking patients who are seen by Spanish speaking doctoral students supervised by Dr. Delgado-Romero.  Dr. Logan provides consultation for all patients seen in the model training program and I provide supervision for English speaking patients primarily and focus on the low SES population.

            “Our program is a win-win because hundreds of patients are receiving behavioral health services, students are being trained in an integrated model, and the faculty are collecting data to determine the added effectiveness of behavioral health within primary care services.  The clinical training program and the research training program are called IMPACT.  The faculty, Mercy staff, and students are totally committed to make this impact happen.”

            APA appreciates the significance of this evolution for education and practice.  Jim Diaz-Granados: “The Education Directorate recognizes the value of interprofessional education and training.  This is evidenced by our active participation in a number of interprofessional organizations.  The APA is a liaison member on the Federation of Associations of Schools of the Health Professions that serves as a forum to encourage effective collaboration among health professions in education and practice.  The Directorate is also a member of the National Academy of Medicine’s Global Forum on Innovations in Health Professions Education, an ongoing convening activity that brings together stakeholders from multiple nations and professions to network, discuss and illuminate issues within health professional education with a focus on interprofessional education.  In 2016, APA joined the Interprofessional Education Collaboration (IPEC).  The IPEC was formed in 2009 by six organizations committed to advancing interprofessional learning experiences and promoting team-based care.  In 2016, IPEC appointed 14 additional members, including the APA.  Our CEO Arthur Evans and APA Presidents Tony Puente, Susan McDaniel, and Jessica Henderson Daniel have accompanied the Education Directorate leadership to the IPEC biannual council meetings.

“Similarly, in April 2017, the APA Commission on Accreditation joined the Health Professions Accreditors Collaborative (HPAC).  The HCAP was founded in 2014 by the accreditors for medicine, pharmacy, nursing, dentistry, and public health and expanded in 2017 to include 17 additional organizations committed to working together to advance interprofessional education, practice, and quality.  In addition to membership in key interprofessional groups, under the leadership of then APA President Susan McDaniel, the curriculum for an Interprofessional Seminar on Integrated Primary Care (IS-IPC) was developed.  The IS-IPC is a resource that can be used to develop educational experiences for an interprofessional group of learners about the competencies needed to work together in a successful and integrated healthcare team.  The next opportunity on the horizon is that of interprofessional continuing education.  Currently, the Joint Accreditation for Interprofessional Continuing Education offers organizations to be simultaneously approved to provide medical, nursing, pharmacy, and optometry continuing education.  In the Education Directorate we are currently exploring the possibility of adding psychology to the mix.”

            Prescriptive Authority (RxP):  As psychology becomes more involved in integrated and interprofessional care, we are confident that the movement towards obtaining RxP will increasingly mature.  At the APAPO Practice Leadership conference Beth Rom-Rymer chaired the concurrent workshop “The Revolution in Health Care: Prescribing Psychologists” where the five successful state associations described how each of their approaches reflected unique needs and circumstances.  Subsequently, Armand Cerbone reflected upon their journey in Illinois: “In 2004 when I became President of the Illinois Psychological Association (IPA), the RxP initiative was languishing.  Having already obtained his authorization in New Mexico, former IPA President Marlin Hoover was the RxP chief advocate.  Yet he found little traction among our Council representatives.  He indicated he was losing his enthusiasm.  Believing that RxP was important, even critical, to the future of psychology, I met with Marlin to bolster his commitment and to plot to advance his proposal and to encourage him to press our Council further.

            “Together we engaged the IPA Council in debate over a motion to adopt as its #1 legislative priority seeking RxP for Illinois psychologists.  There was considerable resistance among Council members citing negative changes to the profession and its values and concerns for the medicalization of psychology.  There were anxieties that prescribing would open the door to abuse of prescriptive authority by unprincipled psychologists interested only in financial gain.  Those who favored such an initiative noted remedies for persons not able to afford or access psychiatric care, improved care stemming from the advantages of consulting with a psychologist with similar training than with a medical doctor, and improving competitiveness in the marketplace.  One proponent of RxP argued that prescriptive authority would broaden a ‘safety net of care’ for clients and patients.

            “Given that in 2005 our Council was composed of middle- to late-career professionals, I polled our IPAGS representative for his opinion.  His support for RxP was clear.  RxP would provide opportunities for new psychologists and strengthen professional credibility in medical settings.  In remarking that there was already considerable emphasis on the biological bases to behavioral health he said it seemed smart to consider how RxP could open doors to the future.  I believe the voice of young people, new to or entering the profession, swayed the fence-straddlers among the representatives.  When the vote was called, the motion carried by a clear majority.  IPA was now committed to RxP.

“Over the next few years Marlin developed a video of interviews with psychologists who had or were pursuing RxP and one Illinois psychiatrist who supported the movement for psychologists.  While the video captured important arguments, it lacked production values that reduced its effectiveness.  More importantly, psychologists of color were noticeably absent.  Much was learned from those initial efforts.  It would require more financial and political resources than IPA had at the time.  And passing RxP legislation in the AMA’s backyard would be daunting.

            “When Beth Rom-Rymer assumed the leadership of IPA, she provided the determination and political savvy the initiative needed.  IPA’s commitment hadn’t wavered but needed the single-minded energy Beth brought.  Beth was also able to pull together from sundry sources the essential financial resources to hire well-established and respected lobbyists to work exclusively for the passage of RxP legislation in the Illinois legislature.  I remember one fund-raising event at her home for the reelection of a Democratic Governor who was likely to sign any RxP legislation that passed the legislature.  Traveling around the state, Beth met with anyone who would meet with her to garner support for RxP and to calm the dubious and rebut the opposed.

            “That RxP is law in Illinois is a measure of Beth’s skill as a resourceful and effective leader.  Illinois would not be among the states with prescriptive authority were it not for her efforts.  Adding Illinois to the roster surely provides encouragement and momentum to the national movement.  Beth was able to capitalize on ground that had been tilled.  What resistance she encountered was from the rank and file who needed the education and leadership she provided.  Several important factors emerged from Illinois’ experience.  As much as vision, unwavering commitment, and capable leadership are critical, it is equally important – at times even more important – to have a grasp of local politics and the financial resources adequate to the objective.  Setbacks happen; movements can stall.  Keep your eyes ever on the prize.”

            Investing in Our Next Generation:  During this year’s deliberations on the FY 2018 Appropriations bill for the Department of Health and Human Services increased funding was provided for two programs within the Health Resources and Services Administration which should be of particular interest to those colleagues concerned about our nation’s children.  Ten million dollars was included for a new initiative to expand access to behavioral health services in pediatric primary care by developing pediatric mental health care telehealth access programs.  And, $22.3 million was provided for EMSC.  On its 10^th anniversary, C. Everett Koop noted: “I am pleased to remember that in 1984, while I was U.S. Surgeon General, the United States Congress passed legislation to improve emergency medical services for children (EMSC).  It received my full support and that of many of my colleagues, because critically ill and injured children were not receiving the same high quality of emergency health care we provided for adults.  But this is not unusual; throughout history children have not been our first priority.”  Neither initiative was in the Administration’s budget.

On March 24^th my wife and I joined a surprising number of neighbors at a local senior retirement community marching on behalf of the next generation (“March for Our Lives”).  It was inspiring to see the number of elderly walking with their canes and/or a bit slower with their walkers, many with proud grandchildren alongside them.  The signs were clear “Protect children, not guns!”  As we went along a major thoroughfare, an impressive number of passing cars enthusiastically expressed their support.  “Roll over Beethoven.”  Aloha,

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

 

ALOHA - D55

“I SAW HER AGAIN LAST NIGHT”

            The 2018 APAPO Practice Leadership Conference:   The APAPO State Leadership Conferences are always the highlight of the year.  Former APA Presidents James Bray and Carol Goodheart were present, joining an impressive cadre of Early Career Psychologists and APAGS graduate students.  This was Katherine Nordal’s final hurrah – the enthusiastic standing ovations she received for her decade of passionate service to APA were well deserved.  Psychology’s future is extraordinarily bright.  The next generation is dedicated to serving the nation in a transformative manner.

            “Thanks to the invitation by Dr. Dan Abrahamson, I attended the Practice Leadership Conference discussion group, ‘Social Justice & Advocacy Matters: Navigating ‘isms’ and Building Allies in SPTAs and Other Professional Settings’ hosted by the Diversity Delegate and facilitated by Dr. Charmain F. Jackman, the current Diversity Delegate Liaison.  As a sixth year doctoral candidate at the Uniformed Services University who studies health disparities, I have spent a great deal of time learning and practicing from a culturally-informed framework through classes, conferences, clinical work, and my own research.  However, this session was, by far, the best session I have ever attended at PLC and at any other class or conference I have ever attended.  Dr. Jackman used what is called the ‘fish bowl protocol’ to facilitate an authentic dialogue on social justice advocacy, navigating ‘isms’ (e.g., racism, sexism) and discrimination in the workplace, incorporating social justice into professional practice, and the roles of allies and ally-ship.

            “Within this protocol, there is an inner circle that consists of six chairs and an outer circle surrounding the inner circle.  At any given time, there are five members in the inner circle and everyone else sits in the outer circle.  There is one chair left empty in the inner circle so that someone from the outer circle can join the inner circle at any point.  Only five people can be in the inner circle at one time, so when someone joins the inner circle, one person must leave to maintain the five-person inner group.  Dr. Jackman presented several prompts throughout the 90-minute session to spur discussion that occurred amongst the people in the inner circle while the attendants in the outer circle listened.  Although, prior to starting, I was a bit nervous about how this protocol would function, it (along with her excellent prompts) made for one of the most intimate, authentic, eye opening, inspiring, empowering, and engaging discussions around personality identity, cultural identity, navigating ‘isms,’ and discrimination I have ever witnessed.

            “There were three prompts, but the first was, by far, my favorite and the one that was continuously woven throughout the others.  She asked the first set of discussants to share how they identify themselves and how their identities inform their professional practice.  Although the question might have been a simple one, the range, variety, passion, and history of the responses was far from it.  To respect the ‘Vegas rule’ we all agreed to prior to beginning the discussion, I will not go into detail about the responses.  I will only say that I was deeply moved by the complexity and depth of the responses, the surprises, the willingness to be authentic and brave, and the genuine and respectful curiosity exhibited by everyone in attendance.  As an African American woman who grew up in the South, I have always been aware of the racial and cultural tensions that exist and have certainly been on the receiving end of racism and discrimination.  However, I was still struck by the stories of people coming from so many races, cultures, religions, socioeconomic statuses, and backgrounds who have had similar and even more extreme experiences.

            “The paradox that exists within the human experience of having so much in common and yet being so different was ever present, and dare I say, beautiful to witness in its full glory.  Indeed, hearing and understanding people’s stories in this way was what initially drew me to the field of psychology.  The 90-minutes went by in a flash.  I felt like I could stay in that room forever.  I’m sure I wasn’t alone in that feeling.  At the end of the session, with just a couple of minutes left, our facilitator asked everyone to share what they got out of the session in one word.  Again, I wasn’t sure if this would work, but boy was I wrong.  Not only was it easy, it was powerful.  The diversity in discussion was matched by the diversity in what everyone’s response was to this request – all the discussants and those of us who didn’t participate but were there to bear witness and honor their stories.  The one-word descriptions were endless, with very few repeats.  We all got something a little different from the session – all beautiful, powerful, and valid.  My word was ‘empowering’ because I left feeling even more confident in the personal and professional work I am pursuing and the personal work I encourage my clients to pursue.  Dr. Jackman (and her team) did a fabulous job putting together this session, and it will undoubtedly inform the way I see others forever” (Omni Cassidy).

            Presidential Citations:  One of the most enjoyable moments of serving as APA President is having the opportunity to publicly recognize colleagues who have made a significant difference in the lives of our nation’s citizenry.  This year two of the pioneering visionaries behind the prescriptive authority (RxP) movement were so recognized: former APA Practice Directorate State Association guru Mike Sullivan by Jessica Daniels and former APA and Division 55 President Ron Fox by Tony Puente.  Unfortunately, Ron passed away this March; however, during his final days, Tony was able to visit him at home and personally present his Citation, which was Tony’s last official act as our national President.  For so many years, Mike was APA’s state advocate – traveling across the country to visit and encourage those seriously considering RxP legislation.  It was most fitting, therefore, that at this year’s APAPO Practice Leadership Conference Jessica was able to honor him.  Without question, but for the efforts of these two dedicated colleagues, the Division and our prescriptive authority quest would never have come to life.  Those of us who believe that obtaining this clinical authority is in the best interest of our profession and our patients owe each of them so much, and yet they asked for so little in return.  Mahalo.

            Mike Sullivan:  “Dr. Michael Sullivan is recognized with this APA Citizen Psychologist Presidential citation as an examplar of sustained activities in his community and across the lifespan.  From his time volunteering in the Peace Corps and later doing alternative civilian service as a conscientious objector in the 1960’s to his current volunteerism 50 years later, Dr. Sullivan brings the same passion and commitment to his community as he did in his many years of service to the State Advocacy Office in the APA Practice Directorate.  Dr. Sullivan has dedicated many volunteer hours to the Meals on Wheels program within Senior Resources, Inc. in support of improving the lives of seniors in Columbia, South Carolina.  He initiated a volunteer recognition initiative within the program to ensure that those who cared for others are also cared for.

            “Dr. Sullivan also applies his psychology advocacy skills as a spokesperson for the Meals on Wheels program addressing the benefits of community engagement for volunteers.  He sees volunteerism as a noble calling which provides him meaning and purpose in retirement by giving back to his community.  By providing meals to homebound and disabled citizens in the Richland County area of South Carolina, Dr. Sullivan appreciates the importance of enabling seniors to live at home rather than in an institution and how human interaction and wellness checks are equally as important to ensuring the safety and well-being of seniors.

            “Dr. Sullivan volunteers in other capacities in his community to include his work at Howlmore Animal Sanctuary exercising special-needs dogs and teaching line dancing with his wife through various local organizations, including a local homeless shelter.  His church has also recognized Dr. Sullivan for his leadership, social justice, and social action work.”

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

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

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

Pat DeLeon, former APA President – Division 55 – March, 2018

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