Personal Involvement: "My experience as a prescribing psychologist has been shaped largely by a solid education in psychopharmacology, serendipity and blissful ignorance. Upon receiving my conditional prescribing license in New Mexico, I left for Washington State and a position with the Department of the Army. I had a job offer in Farmington, New Mexico that would have ensured that I could use my new skill set as a prescriber, but my wife and I wanted to move to the West Coast. The federal position in Washington provided no guarantee that I would be permitted to prescribe. It was my ignorance of how many outstanding prescribing psychologists had NOT been able to prescribe in the Department of Defense that led me to optimistically pursue RxP in an Army hospital. The year was 2008 and the United States was deep into the conflict in the Middle East. The Department of Psychology, at what would later become Joint Base Lewis-McChord, was in a hiring frenzy and it was unceremoniously determined that I would be embedded as a clinical psychologist in a large family medicine department. Being placed in primary care is one of the serendipitous parts of this story. I had never worked in primary care and had no idea how this placement would be ideal for me personally and as a prescribing psychologist.
"I won't belabor the story, but after combatting the standard opposition from the usual sources I was credentialed by the hospital. This only happened with great leadership from the chief of my service, a neuropsychologist, LTC Gary Southwell, and support from my family medicine colleagues who saw great added value in my ability to prescribe psychotropic medications. I was to learn later that getting the approval of the hospital credentialing committee was the hurdle that many deserving prescribing psychologists working in military hospitals were not able to surmount.
"I was now free to develop my practice in this new setting. Over time I developed a model of combining clinical and prescribing psychology practice that my colleagues and I later described in The Journal of Clinical Psychology in Medical Settings in 2012. I regularly complained to my RxP colleagues that we didn't have enough data demonstrating that we are safe, effective providers. So, in the same article I published the results of a confidential, anonymous survey of almost 50 primary care providers with whom I had worked for several years. In this survey I wanted to ask the primary care providers, who shared every patient with me, direct questions about how they perceived and experienced working with a prescribing psychologist. I have argued, and continue to argue, that there is no medical professional better able to assess the safety and efficacy of RxP than primary care providers. They are responsible for the total health of their patients and, while I find my primary care colleagues to be courteous and welcoming, they have virtually no tolerance for unsafe or ineffective treatment by other providers. As an aside, if you are ever lacking in excessive amounts of anxiety I recommend you ask 50 of your closest colleagues to anonymously rate your performance and skills. The results, it turned out, were overwhelmingly positive and I have been gratified that the ensuing article has been used as supporting documentation in numerous RxP legislative initiatives.
"Working as a prescribing psychologist for the past 10 years has been a great opportunity to make a positive difference in patients' lives. Being embedded in primary care has further expanded my knowledge base and afforded my patients with true collaboration between their behavioral health provider and medical providers. Patients appreciate the ease of being able to obtain therapy and medication with one provider. While many patients can have a positive experience working with separate professionals providing therapy and medication management, most of us have seen that system break down from time to time. Referrals for psychopharmacological management by a different provider can result in a variety of problems such as poor communication or disagreement about diagnosis and/or treatment plans, failure of patients to follow up with referrals for psychiatric care, long wait times for psychiatric management, etc. When providing both medication management and therapy there is no lag time in responsiveness to patient needs or changes with regards to medication or therapy.
"Little did I realize when I was embedded in primary care that this was an optimal situation for a prescribing psychologist. All prescribing psychologists are expected to collaborate on some level with the primary care provider of their patients. In my case, those primary care providers are literally no more than a few doors away. This has provided coordinated care on a level I had never considered possible. I have developed reciprocal relationships with the primary care providers in our department such that I am always learning something new about medical diagnoses and treatments as they pertain to my behavioral health patients. In turn, my primary care colleagues avail themselves of curbside consults with me on a regular basis with questions about psychopharmacology and/or clinical psychology.
"As a core faculty member of the family medicine residency at Madigan Army Medical Center (MAMC) I teach medical residents, manage the behavioral health curriculum and engage in research and professional presentations. It turns out that teaching psychopharmacology to prescribers and non-prescribers alike is one of my favorite professional activities. I have found there are few incentives more powerful for continued learning in one's chosen field than having to teach the topic to smart, well-educated people who have high expectations for accuracy and relevance.
"As I became more settled in my position at MAMC, I began to turn my attention to my local environment. The State of Washington has not been immune to the shortage of psychiatric providers that most of the nation is experiencing. Wait time are excessive, access can be bleak, and frequently providers in the community are in such demand that they do not accept low paying Medicare reimbursements, or at least limit the number of Medicare patients on their panels. Some of our counties have few or no psychiatrists and our rural and low-income patients don't have adequate access to high quality psychiatric care. Primary care providers and psychiatric nurse practitioners have tried to make-up for the deficit, but the need continues to grow. In response, I decided to become involved with my State psychological association. As a prescribing psychologist I knew that expanding psychologists' scope of practice to include prescribing psychotropic medication could be a safe and effective way to be part of the solution to poor access to psychiatric care. As a result, I partnered with the Washington State Psychological Association (WSPA) to build an RxP Taskforce of almost two dozen enthusiastic psychologists. We are now pursuing legislation that would allow appropriately trained psychologists to prescribe. The way forward looks to be challenging, but I am encouraged and hopeful that we will get a bill passed. However, if we don't succeed in our first attempt, I believe we can plant seeds for the future that will benefit our patients. If that is the case then we can take refuge in Nelson Henderson's proclamation that 'The true meaning of life is to plant trees, under whose shade you do not expect to sit'" (David Shearer, Clinical and Prescribing Psychologist).
A Data-Based Approach: One of the most intriguing thoughts that comes to mind when involved in the public policy process is the extent to which those colleagues in academia and clinical practice and those on the Hill (including at the State level) seem to live in two distinct worlds, with their own unique languages and sense of timing. In 2014 the Institute of Medicine (IOM) (now the National Academy of Medicine) convened a workshop entitled "Considerations in Applying Benefit-Cost Analysis to Preventive Interventions for Children, Youth, and Families." Kimber Bogard (Senior Vice President for Strategy and Programs at the New York Academy of Medicine and previously Director of the Board on Children, Youth, and Families at the IOM) served as one of the rapporteurs.
All would agree that benefit-cost analysis holds great promise for influencing policies related to these populations. By comparing the costs with the long-term benefits, this approach could provide an important tool for determining what kinds of investments have the greatest potential to reduce the physical, mental, and behavioral health problems of young people. However, its utility has been limited by a lack of uniformity in the methods and assumptions underlying various studies. For example, researchers use a variety of techniques to calculate the costs of a program and the benefits it produces. For years, those who perform and those who use benefit-cost analyses have argued that the development and use of theoretical, technical, and reporting standards would enhance the validity of results, increase comparability across studies, and accelerate the progress of the field. Perhaps the establishment of national clearinghouses for the dissemination of the results of findings would be appropriate.
In my view, one of the most impressive presentations was by the Washington State Institute for Public Policy which was created in 1983 by the State's legislature to carry out practical, nonpartisan research at the direction of the legislature or the Institute's Board of Directors. Over the years, the Institute has explored a range of topics including crime, education and early education, child abuse and neglect, substance abuse, mental health, health care, and housing among others. It employs a three-step process to determine benefits and costs. First, it examines what works to improve outcomes and what does not work – not limiting itself to the State of Washington. Second, what is the return on investment by computing the benefits, costs, and risks to the people of Washington? And third, it uses this information to help form budgets by exploring how a combination of options would affect statewide outcomes. It tries to present these in a Consumer Reports style, so the results look the same for a legislator working on K-12 education and for a legislator working on the juvenile justice system.
Their Lessons Learned include: * the results of benefits-analyses need to compare apples to apples, not apples to oranges. Legislators are routinely provided with various options to consider. * Results have to be understandable by all 147 members of the legislature – or at least by the Committee Chairs, the Majority Leader, and the Ranking Members. * Results are calculated on an annual cash flow basis from three perspectives: that of taxpayers, that of participants in the program; and that of others who are affected by the program, such as victims of crimes. * The effect size of a program is important, but so is the risk associated with that estimate and its uncertainty. * Local conditions vary and thus the results of benefit-cost analysis will also. * Greater use of longitudinal research is sought. * And, one should borrow the best current thinking on the valuation of outcomes. Work needs to be adapted to local circumstances, rather than necessarily redone. When, for example, the Institute demonstrated that by investing in a portfolio of evidence-based crime prevention programs the State legislature could reduce crime rates, avoid the need to construct a new prison, and save taxpayers $2 billion, this resulted in the enactment of relevant legislation. As former APA President Alan Kazdin has consistently argued, relying excessively upon randomized controlled experiments and reporting only statistically significant findings can prevent real benefits from occurring. Further, serendipitous secondary findings can lead to new research avenues that in the long-run significantly advance the field.
Honoring Those Who Serve: Jennifer Kelly served on the APA Board of Directors for nine years, including two terms as Recording Secretary. "I had the opportunity to attend the VA Psychology Leadership Conference, held in San Antonio, Texas on May 28-31. The theme of the conference was: 'Promoting Quality, Integrated Healthcare for All Veterans.' The meeting began with a dinner to celebrate the retirement of Russell Lemle. Dr. Lemle, a pioneer and principle organizer of the conference, was the Chief Psychologist at the San Francisco VA Medical Center and Clinical Professor in the Department of Psychiatry, UCSF. In addition to honoring the life and legacy of Dr. Lemle, the dinner was a history lesson about the conference. During the evening I learned how the VA is the largest employer of psychologists. As the conference progressed, I also learned how the VA is managing difficult issues such as the suicide rate among our nation's Veterans, the opioid crisis, Integrated Care or Whole Health Transformation, and Women in Leadership. I left the conference with the feeling that the VA is working hard to ensure that the care of our Veterans is in good hands. This is yet another aspect of our profession that is making a difference in people's lives." "You have to spend it to make a difference." [Kamala Harris]. Aloha,
Pat DeLeon, former APA President – Division 42 – August, 2019
Sent from my iPhone
Sunday, September 22, 2019
Thursday, June 13, 2019
TRANSFORMATIONAL CHANGE
The Practice Leadership Conference is always the highlight of my APA year. Once again, Dan Abrahamson and Susie Lazaroff did an outstanding job this spring, with nearly 400 of our colleagues actively participating in Advocacy and Leadership. Jared Skillings' visionary Welcoming Remarks nicely set the stage for the exciting conference. "These are exciting times. We're at the start of a new era for APA and professional psychology. It is an era that offers each and every one of us tremendous opportunities." One of aspects of these conferences which I most appreciate is the wide range of important topics to which the attendees become exposed. From my perspective the Department of Defense (DOD) has two major complementary missions: enhancing national security and fostering humanitarian efforts worldwide. DOD's humanitarian efforts can be considered preventive in nature; and, as such, although extraordinarily important and highly cost-effective in the long-run, they are constantly subject to cost-containment concerns, especially by those emphasizing budgetary priorities. Accordingly, this must become a critical focus for military psychology's leadership. One of our policy seminar speakers at the Uniformed Services University, a former Vietnam War POW, recently commented that the military has many fine managers; however, leadership is different.
To become a successful leader one must understand and honor the past. At this year's conference Gary Howell chaired a workshop addressing psychology's potential for ameliorating today's humanitarian crisis on our Southwest border. Shirley Higuchi and Giselle Hass provide an important global perspective: "Psychologists have long understood how separating family members can exact a long-term toll on children, creating traumas spanning multiple generations. During a February forum on Capitol Hill, Arthur Evans compared the World War II Japanese American incarceration with the plight of immigrants to the United States who have been placed in detention camps while they await their claim for asylum. The incarceration broke up families, which had serious effects on the children as they grew older. That impact is similar to the separation of families at the border, which particularly damages children. 'The bond established with a parent is important, particularly early in life. When that attachment is disrupted, children experience anxiety and depression.'"
Recently Arthur and his wife, and separately my wife and I, visited the site of the former Japanese American camp at Heart Mountain, Wyoming – an experience which affected each of us profoundly. Many things struck us. How can our government do this? How we can make other people 'the others' is how we can do that. Representative Mark Takano, Chairman of the House Veterans Affairs Committee: "I never thought that my being in Congress and my parents being in internment camps would be so relevant now. The difference between now and 1942 was that no one was speaking out on behalf of the Japanese Americans at that time."
Sam Mihara, a Heart Mountain Foundation board member and incarceree as a child, said the incarceration devastated his family, including how the incorrect treatment of his grandfather's colon cancer caused him to die prematurely. "In two weeks, I saw him wither away to skin and bones. He was like a Holocaust survivor." Visiting multiple detention camps for immigrants it is clear the children are given a poor diet, lots of bread and pasta and few fresh vegetables and protein. Just as the Japanese American children did, these immigrant children receive the message that they are unwanted, socially rejected, that their human rights are not important, and that they do not deserve any care by the government who should protect them.
Giselle is an immigrant from Central America who has focused her psychological research and clinical work on immigrants and the unjust situations they endure in the United States. She and Shirley have spoken in several forums, including teaching the judges, lawyers and other members of the National Consortium for Racial and Ethnic Fairness in the Courts on the similarities between what happened during World War II and today. One lesson learned is how the incarceration experience has shaped the Japanese Americans in ways that so many are just discovering now, more than 75 years after they and their ancestors were first incarcerated. Silence is the first coping trait; many Japanese Americans felt too much shame to speak about what happened to them. For years, they wanted to be anything than what they were. Some strove so hard to assimilate into white-dominated "American" culture that they lost their sense of identity and community. Others compensated by working so hard that no one could question their place in society. That workaholism often cost them healthy relationships with their families. For some, perfectionism became their path to acceptance. Everything they did had to be better than anyone else lest they lose their place in society. Former Cabinet member Norman Mineta talked about the shame he felt being labeled an "enemy alien" as a child and his determination to show that he was an American as anyone else. The Latino families and children targeted by our current border and immigration policies face the same fate. Only our memory of the Japanese American incarceration and commitment to social justice can prevent a new round of multigenerational trauma.
The Heart Mountain Wyoming Foundation, chaired by Shirley, runs a very impressive and definitely emotionally moving museum on the site of the Heart Mountain camp, where her parents met as children. The foundation is dedicated to preserving the memory of the incarceration in the hopes that knowledge will prevent it from happening again.
An Exciting Opportunity: On April 3rd, 2017 Idaho became the fifth state to allow prescriptive authority (RxP) for psychologists. Their legislation passed both houses of the legislature without any serious opposition and with only two "nay" votes. Susan Farber reports: "Idaho's Clinical Psychopharmacology Master's program is up and running at Idaho State University (ISU). New students now are being accepted for fall entrance. It is the only program in the country where students can obtain a master's degree after two years that includes pre-degree practicum work. Classes are held on Thursday and Friday. The majority of pre-master's patient-facing work is done over each summer. Consideration will be given to transferring appropriate work in other programs on a case-by-case basis. The program is being taught in a new facility next to Boise that is one of the most advanced healthcare training facilities in the country. Multidisciplinary contributions are the norm. For a full Idaho prescribing certificate, students do supervised clinical fellowship work for two years after their didactic training. For further information contact Page Haviland (US Navy Veteran), the ISU program consultant at pagehaviland@gmail.com,or Erik Silk, the program director, at silkeric@isu.edu.
"The rules for RxP were created by an advisory board consisting of nominees from the Boards of Psychology, Medicine and Pharmacy. They are in temporary effect until the legislature convenes next winter. A dispute within the legislature has affected all rules, not just ours, and put them in the hands of the Governor's office. Because of the intense vetting, our lobbyist is confident ours are in no danger. Many members of the Idaho Psychological Association plus our Executive Director, Deb Katz, and lobbyist have worked on the RxP initiative. We are very proud of this premier contribution to psychology and to the deeply underserved people of our state and of the nation." Personally, over the years, I have come to appreciate the uniqueness of the military culture and thus have been very pleased with the extent to which those involved in this particular training initiative clearly embrace this from their own experiences. "From where I stand, the future of our profession – the future of the this association – looks very promising, not in spite of the changes we face, but because of them" [Jared Skillings]. Aloha,
Pat DeLeon, former APA President – Division 19 – May, 2019
Sent from my iPhone
To become a successful leader one must understand and honor the past. At this year's conference Gary Howell chaired a workshop addressing psychology's potential for ameliorating today's humanitarian crisis on our Southwest border. Shirley Higuchi and Giselle Hass provide an important global perspective: "Psychologists have long understood how separating family members can exact a long-term toll on children, creating traumas spanning multiple generations. During a February forum on Capitol Hill, Arthur Evans compared the World War II Japanese American incarceration with the plight of immigrants to the United States who have been placed in detention camps while they await their claim for asylum. The incarceration broke up families, which had serious effects on the children as they grew older. That impact is similar to the separation of families at the border, which particularly damages children. 'The bond established with a parent is important, particularly early in life. When that attachment is disrupted, children experience anxiety and depression.'"
Recently Arthur and his wife, and separately my wife and I, visited the site of the former Japanese American camp at Heart Mountain, Wyoming – an experience which affected each of us profoundly. Many things struck us. How can our government do this? How we can make other people 'the others' is how we can do that. Representative Mark Takano, Chairman of the House Veterans Affairs Committee: "I never thought that my being in Congress and my parents being in internment camps would be so relevant now. The difference between now and 1942 was that no one was speaking out on behalf of the Japanese Americans at that time."
Sam Mihara, a Heart Mountain Foundation board member and incarceree as a child, said the incarceration devastated his family, including how the incorrect treatment of his grandfather's colon cancer caused him to die prematurely. "In two weeks, I saw him wither away to skin and bones. He was like a Holocaust survivor." Visiting multiple detention camps for immigrants it is clear the children are given a poor diet, lots of bread and pasta and few fresh vegetables and protein. Just as the Japanese American children did, these immigrant children receive the message that they are unwanted, socially rejected, that their human rights are not important, and that they do not deserve any care by the government who should protect them.
Giselle is an immigrant from Central America who has focused her psychological research and clinical work on immigrants and the unjust situations they endure in the United States. She and Shirley have spoken in several forums, including teaching the judges, lawyers and other members of the National Consortium for Racial and Ethnic Fairness in the Courts on the similarities between what happened during World War II and today. One lesson learned is how the incarceration experience has shaped the Japanese Americans in ways that so many are just discovering now, more than 75 years after they and their ancestors were first incarcerated. Silence is the first coping trait; many Japanese Americans felt too much shame to speak about what happened to them. For years, they wanted to be anything than what they were. Some strove so hard to assimilate into white-dominated "American" culture that they lost their sense of identity and community. Others compensated by working so hard that no one could question their place in society. That workaholism often cost them healthy relationships with their families. For some, perfectionism became their path to acceptance. Everything they did had to be better than anyone else lest they lose their place in society. Former Cabinet member Norman Mineta talked about the shame he felt being labeled an "enemy alien" as a child and his determination to show that he was an American as anyone else. The Latino families and children targeted by our current border and immigration policies face the same fate. Only our memory of the Japanese American incarceration and commitment to social justice can prevent a new round of multigenerational trauma.
The Heart Mountain Wyoming Foundation, chaired by Shirley, runs a very impressive and definitely emotionally moving museum on the site of the Heart Mountain camp, where her parents met as children. The foundation is dedicated to preserving the memory of the incarceration in the hopes that knowledge will prevent it from happening again.
An Exciting Opportunity: On April 3rd, 2017 Idaho became the fifth state to allow prescriptive authority (RxP) for psychologists. Their legislation passed both houses of the legislature without any serious opposition and with only two "nay" votes. Susan Farber reports: "Idaho's Clinical Psychopharmacology Master's program is up and running at Idaho State University (ISU). New students now are being accepted for fall entrance. It is the only program in the country where students can obtain a master's degree after two years that includes pre-degree practicum work. Classes are held on Thursday and Friday. The majority of pre-master's patient-facing work is done over each summer. Consideration will be given to transferring appropriate work in other programs on a case-by-case basis. The program is being taught in a new facility next to Boise that is one of the most advanced healthcare training facilities in the country. Multidisciplinary contributions are the norm. For a full Idaho prescribing certificate, students do supervised clinical fellowship work for two years after their didactic training. For further information contact Page Haviland (US Navy Veteran), the ISU program consultant at pagehaviland@gmail.com,or Erik Silk, the program director, at silkeric@isu.edu.
"The rules for RxP were created by an advisory board consisting of nominees from the Boards of Psychology, Medicine and Pharmacy. They are in temporary effect until the legislature convenes next winter. A dispute within the legislature has affected all rules, not just ours, and put them in the hands of the Governor's office. Because of the intense vetting, our lobbyist is confident ours are in no danger. Many members of the Idaho Psychological Association plus our Executive Director, Deb Katz, and lobbyist have worked on the RxP initiative. We are very proud of this premier contribution to psychology and to the deeply underserved people of our state and of the nation." Personally, over the years, I have come to appreciate the uniqueness of the military culture and thus have been very pleased with the extent to which those involved in this particular training initiative clearly embrace this from their own experiences. "From where I stand, the future of our profession – the future of the this association – looks very promising, not in spite of the changes we face, but because of them" [Jared Skillings]. Aloha,
Pat DeLeon, former APA President – Division 19 – May, 2019
Sent from my iPhone
Wednesday, June 12, 2019
ALOHA - D19
TRANSFORMATIONAL CHANGE
The Practice Leadership Conference is always the highlight of my APA year. Once again, Dan Abrahamson and Susie Lazaroff did an outstanding job this spring, with nearly 400 of our colleagues actively participating in Advocacy and Leadership. Jared Skillings’ visionary Welcoming Remarks nicely set the stage for the exciting conference. “These are exciting times. We’re at the start of a new era for APA and professional psychology. It is an era that offers each and every one of us tremendous opportunities.” One of aspects of these conferences which I most appreciate is the wide range of important topics to which the attendees become exposed. From my perspective the Department of Defense (DOD) has two major complementary missions: enhancing national security and fostering humanitarian efforts worldwide. DOD’s humanitarian efforts can be considered preventive in nature; and, as such, although extraordinarily important and highly cost-effective in the long-run, they are constantly subject to cost-containment concerns, especially by those emphasizing budgetary priorities. Accordingly, this must become a critical focus for military psychology’s leadership. One of our policy seminar speakers at the Uniformed Services University, a former Vietnam War POW, recently commented that the military has many fine managers; however, leadership is different.
To become a successful leader one must understand and honor the past. At this year’s conference Gary Howell chaired a workshop addressing psychology’s potential for ameliorating today’s humanitarian crisis on our Southwest border. Shirley Higuchi and Giselle Hass provide an important global perspective: “Psychologists have long understood how separating family members can exact a long-term toll on children, creating traumas spanning multiple generations. During a February forum on Capitol Hill, Arthur Evans compared the World War II Japanese American incarceration with the plight of immigrants to the United States who have been placed in detention camps while they await their claim for asylum. The incarceration broke up families, which had serious effects on the children as they grew older. That impact is similar to the separation of families at the border, which particularly damages children. ‘The bond established with a parent is important, particularly early in life. When that attachment is disrupted, children experience anxiety and depression.’”
Recently Arthur and his wife, and separately my wife and I, visited the site of the former Japanese American camp at Heart Mountain, Wyoming – an experience which affected each of us profoundly. Many things struck us. How can our government do this? How we can make other people ‘the others’ is how we can do that. Representative Mark Takano, Chairman of the House Veterans Affairs Committee: “I never thought that my being in Congress and my parents being in internment camps would be so relevant now. The difference between now and 1942 was that no one was speaking out on behalf of the Japanese Americans at that time.”
Sam Mihara, a Heart Mountain Foundation board member and incarceree as a child, said the incarceration devastated his family, including how the incorrect treatment of his grandfather’s colon cancer caused him to die prematurely. “In two weeks, I saw him wither away to skin and bones. He was like a Holocaust survivor.” Visiting multiple detention camps for immigrants it is clear the children are given a poor diet, lots of bread and pasta and few fresh vegetables and protein. Just as the Japanese American children did, these immigrant children receive the message that they are unwanted, socially rejected, that their human rights are not important, and that they do not deserve any care by the government who should protect them.
Giselle is an immigrant from Central America who has focused her psychological research and clinical work on immigrants and the unjust situations they endure in the United States. She and Shirley have spoken in several forums, including teaching the judges, lawyers and other members of the National Consortium for Racial and Ethnic Fairness in the Courts on the similarities between what happened during World War II and today. One lesson learned is how the incarceration experience has shaped the Japanese Americans in ways that so many are just discovering now, more than 75 years after they and their ancestors were first incarcerated. Silence is the first coping trait; many Japanese Americans felt too much shame to speak about what happened to them. For years, they wanted to be anything than what they were. Some strove so hard to assimilate into white-dominated “American” culture that they lost their sense of identity and community. Others compensated by working so hard that no one could question their place in society. That workaholism often cost them healthy relationships with their families. For some, perfectionism became their path to acceptance. Everything they did had to be better than anyone else lest they lose their place in society. Former Cabinet member Norman Mineta talked about the shame he felt being labeled an “enemy alien” as a child and his determination to show that he was an American as anyone else. The Latino families and children targeted by our current border and immigration policies face the same fate. Only our memory of the Japanese American incarceration and commitment to social justice can prevent a new round of multigenerational trauma.
The Heart Mountain Wyoming Foundation, chaired by Shirley, runs a very impressive and definitely emotionally moving museum on the site of the Heart Mountain camp, where her parents met as children. The foundation is dedicated to preserving the memory of the incarceration in the hopes that knowledge will prevent it from happening again.
An Exciting Opportunity: On April 3rd, 2017 Idaho became the fifth state to allow prescriptive authority (RxP) for psychologists. Their legislation passed both houses of the legislature without any serious opposition and with only two “nay” votes. Susan Farber reports: “Idaho’s Clinical Psychopharmacology Master’s program is up and running at Idaho State University (ISU). New students now are being accepted for fall entrance. It is the only program in the country where students can obtain a master’s degree after two years that includes pre-degree practicum work. Classes are held on Thursday and Friday. The majority of pre-master’s patient-facing work is done over each summer. Consideration will be given to transferring appropriate work in other programs on a case-by-case basis. The program is being taught in a new facility next to Boise that is one of the most advanced healthcare training facilities in the country. Multidisciplinary contributions are the norm. For a full Idaho prescribing certificate, students do supervised clinical fellowship work for two years after their didactic training. For further information contact Page Haviland (US Navy Veteran), the ISU program consultant at pagehaviland@gmail.com,or Erik Silk, the program director, at silkeric@isu.edu.
“The rules for RxP were created by an advisory board consisting of nominees from the Boards of Psychology, Medicine and Pharmacy. They are in temporary effect until the legislature convenes next winter. A dispute within the legislature has affected all rules, not just ours, and put them in the hands of the Governor’s office. Because of the intense vetting, our lobbyist is confident ours are in no danger. Many members of the Idaho Psychological Association plus our Executive Director, Deb Katz, and lobbyist have worked on the RxP initiative. We are very proud of this premier contribution to psychology and to the deeply underserved people of our state and of the nation.” Personally, over the years, I have come to appreciate the uniqueness of the military culture and thus have been very pleased with the extent to which those involved in this particular training initiative clearly embrace this from their own experiences. “From where I stand, the future of our profession – the future of the this association – looks very promising, not in spite of the changes we face, but because of them” [Jared Skillings]. Aloha,
Pat DeLeon, former APA President – Division 19 – May, 2019
Wednesday, June 5, 2019
TINY BUBBLES IN THE WINE
The Modern Era of Technology: Back on April 27, 2004, President George W. Bush highlighted the importance for the nation of our health care system embracing the exciting potential of utilizing the advances in the communications and technology fields to provide the highest quality, cutting-edge care to our citizenry. "Today we're going to talk about (how) to make sure America is innovative and is a leader in the world, and that is how to make sure our health care system works better. And there are some fantastic ideas as to how to do that. The way I like to kind of try to describe health care is, on the research side, we're the best…. Except when you think about the provider's side, we're kind of still in the buggy era…. There's a lot of talk about productivity gains in our society, and that's because companies and industries have properly used information technology. If properly used, it is an industry-changer for the good. It enables there to be a better cost structure and better quality care delivered, in this case in the health field. And, yet the health care industry hasn't touched it, except for certain areas. And one area that has is the Veterans Administration…. And one of the reasons the Veterans Administration is doing so well in changing, kind of, behavior… is because of our Secretary, a Vietnam Vet, a really decent guy, and who is doing a fabulous job, Tony Principi." Senior VA psychologists will recall that Secretary Principi attended the VA Psychology Leadership Conference, sponsored now by APA, Division 18, and AVAPL, during my APA Presidency.
Webinars: Ray Folen, Executive Director of the Hawaii Psychological Association (HPA): "In the mid-90's psychologists at Tripler Army Medical Center were providing counseling and psychotherapy using inexpensive videophones that – by today's standards – offered unimaginably low bandwidth. The video was often slow and pixelated, but it was sufficient – if barely so – to deliver needed services to those located in distant parts of the world. These early pioneering efforts demonstrated the utility and efficacy of this communications medium. Since then, of course, access to high bandwidth connectivity has increased tremendously, resulting in broad coverage and improved quality. The DOD and VA now embrace telehealth and, in particular, the use of behavioral telehealth.
"Videoconferencing for training and educational purposes has followed an evolutionary path similar to behavioral telehealth services. Compared to behavioral telehealth, though, the videoconference centers of the 90's had greater bandwidth (still pathetically low in today's terms). These centers were rare to find and required significant amounts of money, time and effort to operate. Videoconference sessions were highly complex events, typically requiring a dedicated videoconference room with $50K of equipment, full-time technical staff and extensive pre-session preparation. Despite all this effort, conference calls failed more often than not due to a myriad of technical problems: frozen screens, lost audio, lost connections, etc. As a result, these rooms were dark and unoccupied 95% of the time – it was simply too much trouble.
"The extraordinary changes in technology and bandwidth since that time have made videoconferencing available to just about anyone with a computer or smart device. Recently, HPA completed what may be our 100th videoconference session – an all-day in-person workshop that was simultaneously broadcast via the web to HPA members who attended the event from the comfort of their office or home. To date, 98% of our videoconference webinar workshops, presentations and meetings have been problem-free. They require a computer, a separate microphone and camera, and decent Wi-Fi connectivity. If Wi-Fi is not available, a cell phone with a 'hot spot' has provided an adequate Wi-Fi connection, as webinar platforms like 'Zoom' are very forgiving of variations in bandwidth and connectivity; audio and video quality has consistently been good.
"HPA now has highly-regarded researchers and authors giving presentations to us from all over the world. Costs are very low, given that a presentation via webinar requires no travel time or travel expenses. Almost without exception, invitations to present have received a positive response. The webinar format has become extremely popular with our members, who are now receiving excellent training in a very convenient format at very low cost."
The National Academy of Medicine (NAM) of the National Academies of Sciences, Engineering and Medicine has developed an impressive series of webinars addressing a wide range of critical global topics. This June the Culture of Health (on which Hortensia de los Angeles Amaro, Velma McBride Murry, and I have the honor of serving) will be hosting Messaging to Advance Health Equity in Public Policy. Co-Director Ivory Clarke effectively keeps stressing to the committee the importance of the community voice – ensuring that communities are continuously brought to the table and their unique expertise elevated if policy makers want to succeed. "Health equity is crucial and health inequity is costly. Communities across the country are deploying action strategies to reduce health inequities." Value-based messaging has proven effective in creating common ground to advance necessary change [https://nam.edu/event/messaging-to-advance-health-equity-in-public-policy/].
Under the visionary leadership of Morgan Sammons, the National Register has initiated a series of cutting-edge Clinical Webinars for health service psychologists, including this May Psychopharmacology Training and Legislation Update. "Webinars have become a quite effective vehicle for educating and disseminating valuable information to far-flung communities of psychologists. Gery Rodriguez-Menendez, Chair of the Clinical Psychopharmacology Department at the Chicago School of Professional Psychology, and I are conducting a webinar during which we will discuss the Illinois path to RxP legislative success and name the critical factors that any state could use to achieve RxP success. We will also be discussing the Illinois model of training for the prescribing psychologist that reflects our statutory requirements.
"The Chicago School of Professional Psychology is the only School, nationally, whose faculty are training psychology students, who have chosen to become prescribing psychologists, at the predoctoral level. Pursuant to the February, 2019 decision by the APA Council of Representatives to support the predoctoral training in Clinical Psychopharmacology, we expect that schools, nationwide, will begin to train predoctoral psychology students in Clinical Psychopharmacology, following our lead and that of NOVA Southeastern University, whose faculty trained predoctoral psychology students in the early 2000's.
"Every day, I receive calls from practicing psychologists. They have decided to begin their training to become prescribing psychologists because of the dire shortages of psychiatrists and of other healthcare professionals who have competence in diagnosing mental illness and prescribing psychotropic medications. A 2015 study by Princeton University researchers found that when advanced practice nurses were granted independent prescriptive authority in their states, the suicide rate, in those states, plummeted by 12%. I believe that we will see similar statistics in the states in which we have independently prescribing psychologists" (Beth Rom-Rymer, APA Board of Directors).
Licensure Mobility: One of the most significant consequences of the growing impact of technology on the health care field is the critical importance of licensure mobility for practitioners. "PSYPACT is operational! The Psychology Interjurisdictional Compact (PSYPACT) is an interstate compact designed to facilitate the practice of tele-psychology and the temporary in-person, face-to-face practice of psychology across state boundaries. PSYPACT allows psychologists to provide electronic psychological services from their home compact state to a patient in a distant compact state without having to be licensed in the distant state. It also allows psychologists to temporarily physically go into another compact state to provide face-to-face psychological services without having to be also licensed in that distant state. Legislative action by states is needed to adopt PSYPACT into law in their state. PSYPACT became operational once seven states adopted it. Now the PSYPACT Commission will be set up to develop the bylaws and oversee PSYPACT. This commission will be made up of one delegate from each compact state.
"As of May 1st 2019, PSYPACT is alive! The following states have adopted the necessary legislation: Arizona, Utah, Nevada, Colorado, Missouri, Nebraska, Georgia, Oklahoma, and Illinois (effective January 1st 2020). There is also active legislation in Rhode Island, New Hampshire, North Carolina, Texas, the District of Columbia, and Pennsylvania. Psychologists in these states are urged to contact their own legislators to support PSYPACT. For psychologists in compact states who want to provide interjurisdictional tele-psychology services to patients in other compact states, they will have to apply for an E.Passport and for those who want to temporarily provide in person, face-to-face services in other compact states, they will have to apply for an Interjurisdictional Practice Certificate (IPC)" (Alex Siegel, asiegel@asppb.org)." Our personal congratulations to Steve DeMers, former ASPPB Executive Director; Gerald O'Brien, President); and Mariann Burnetti-Atwell, CEO for their vision and persistence in successfully implementing this very important and timely APA Council Policy. "Make me warm all over" (Don Ho). Aloha,
Pat DeLeon, former APA President – Division 42 – May, 2019
Sent from my iPhone
Webinars: Ray Folen, Executive Director of the Hawaii Psychological Association (HPA): "In the mid-90's psychologists at Tripler Army Medical Center were providing counseling and psychotherapy using inexpensive videophones that – by today's standards – offered unimaginably low bandwidth. The video was often slow and pixelated, but it was sufficient – if barely so – to deliver needed services to those located in distant parts of the world. These early pioneering efforts demonstrated the utility and efficacy of this communications medium. Since then, of course, access to high bandwidth connectivity has increased tremendously, resulting in broad coverage and improved quality. The DOD and VA now embrace telehealth and, in particular, the use of behavioral telehealth.
"Videoconferencing for training and educational purposes has followed an evolutionary path similar to behavioral telehealth services. Compared to behavioral telehealth, though, the videoconference centers of the 90's had greater bandwidth (still pathetically low in today's terms). These centers were rare to find and required significant amounts of money, time and effort to operate. Videoconference sessions were highly complex events, typically requiring a dedicated videoconference room with $50K of equipment, full-time technical staff and extensive pre-session preparation. Despite all this effort, conference calls failed more often than not due to a myriad of technical problems: frozen screens, lost audio, lost connections, etc. As a result, these rooms were dark and unoccupied 95% of the time – it was simply too much trouble.
"The extraordinary changes in technology and bandwidth since that time have made videoconferencing available to just about anyone with a computer or smart device. Recently, HPA completed what may be our 100th videoconference session – an all-day in-person workshop that was simultaneously broadcast via the web to HPA members who attended the event from the comfort of their office or home. To date, 98% of our videoconference webinar workshops, presentations and meetings have been problem-free. They require a computer, a separate microphone and camera, and decent Wi-Fi connectivity. If Wi-Fi is not available, a cell phone with a 'hot spot' has provided an adequate Wi-Fi connection, as webinar platforms like 'Zoom' are very forgiving of variations in bandwidth and connectivity; audio and video quality has consistently been good.
"HPA now has highly-regarded researchers and authors giving presentations to us from all over the world. Costs are very low, given that a presentation via webinar requires no travel time or travel expenses. Almost without exception, invitations to present have received a positive response. The webinar format has become extremely popular with our members, who are now receiving excellent training in a very convenient format at very low cost."
The National Academy of Medicine (NAM) of the National Academies of Sciences, Engineering and Medicine has developed an impressive series of webinars addressing a wide range of critical global topics. This June the Culture of Health (on which Hortensia de los Angeles Amaro, Velma McBride Murry, and I have the honor of serving) will be hosting Messaging to Advance Health Equity in Public Policy. Co-Director Ivory Clarke effectively keeps stressing to the committee the importance of the community voice – ensuring that communities are continuously brought to the table and their unique expertise elevated if policy makers want to succeed. "Health equity is crucial and health inequity is costly. Communities across the country are deploying action strategies to reduce health inequities." Value-based messaging has proven effective in creating common ground to advance necessary change [https://nam.edu/event/messaging-to-advance-health-equity-in-public-policy/].
Under the visionary leadership of Morgan Sammons, the National Register has initiated a series of cutting-edge Clinical Webinars for health service psychologists, including this May Psychopharmacology Training and Legislation Update. "Webinars have become a quite effective vehicle for educating and disseminating valuable information to far-flung communities of psychologists. Gery Rodriguez-Menendez, Chair of the Clinical Psychopharmacology Department at the Chicago School of Professional Psychology, and I are conducting a webinar during which we will discuss the Illinois path to RxP legislative success and name the critical factors that any state could use to achieve RxP success. We will also be discussing the Illinois model of training for the prescribing psychologist that reflects our statutory requirements.
"The Chicago School of Professional Psychology is the only School, nationally, whose faculty are training psychology students, who have chosen to become prescribing psychologists, at the predoctoral level. Pursuant to the February, 2019 decision by the APA Council of Representatives to support the predoctoral training in Clinical Psychopharmacology, we expect that schools, nationwide, will begin to train predoctoral psychology students in Clinical Psychopharmacology, following our lead and that of NOVA Southeastern University, whose faculty trained predoctoral psychology students in the early 2000's.
"Every day, I receive calls from practicing psychologists. They have decided to begin their training to become prescribing psychologists because of the dire shortages of psychiatrists and of other healthcare professionals who have competence in diagnosing mental illness and prescribing psychotropic medications. A 2015 study by Princeton University researchers found that when advanced practice nurses were granted independent prescriptive authority in their states, the suicide rate, in those states, plummeted by 12%. I believe that we will see similar statistics in the states in which we have independently prescribing psychologists" (Beth Rom-Rymer, APA Board of Directors).
Licensure Mobility: One of the most significant consequences of the growing impact of technology on the health care field is the critical importance of licensure mobility for practitioners. "PSYPACT is operational! The Psychology Interjurisdictional Compact (PSYPACT) is an interstate compact designed to facilitate the practice of tele-psychology and the temporary in-person, face-to-face practice of psychology across state boundaries. PSYPACT allows psychologists to provide electronic psychological services from their home compact state to a patient in a distant compact state without having to be licensed in the distant state. It also allows psychologists to temporarily physically go into another compact state to provide face-to-face psychological services without having to be also licensed in that distant state. Legislative action by states is needed to adopt PSYPACT into law in their state. PSYPACT became operational once seven states adopted it. Now the PSYPACT Commission will be set up to develop the bylaws and oversee PSYPACT. This commission will be made up of one delegate from each compact state.
"As of May 1st 2019, PSYPACT is alive! The following states have adopted the necessary legislation: Arizona, Utah, Nevada, Colorado, Missouri, Nebraska, Georgia, Oklahoma, and Illinois (effective January 1st 2020). There is also active legislation in Rhode Island, New Hampshire, North Carolina, Texas, the District of Columbia, and Pennsylvania. Psychologists in these states are urged to contact their own legislators to support PSYPACT. For psychologists in compact states who want to provide interjurisdictional tele-psychology services to patients in other compact states, they will have to apply for an E.Passport and for those who want to temporarily provide in person, face-to-face services in other compact states, they will have to apply for an Interjurisdictional Practice Certificate (IPC)" (Alex Siegel, asiegel@asppb.org)." Our personal congratulations to Steve DeMers, former ASPPB Executive Director; Gerald O'Brien, President); and Mariann Burnetti-Atwell, CEO for their vision and persistence in successfully implementing this very important and timely APA Council Policy. "Make me warm all over" (Don Ho). Aloha,
Pat DeLeon, former APA President – Division 42 – May, 2019
Sent from my iPhone
Tuesday, June 4, 2019
ALOHA
“TINY BUBBLES IN THE WINE”
The Modern Era of Technology: Back on April 27, 2004, President George W. Bush highlighted the importance for the nation of our health care system embracing the exciting potential of utilizing the advances in the communications and technology fields to provide the highest quality, cutting-edge care to our citizenry. “Today we’re going to talk about (how) to make sure America is innovative and is a leader in the world, and that is how to make sure our health care system works better. And there are some fantastic ideas as to how to do that. The way I like to kind of try to describe health care is, on the research side, we’re the best…. Except when you think about the provider’s side, we’re kind of still in the buggy era…. There’s a lot of talk about productivity gains in our society, and that’s because companies and industries have properly used information technology. If properly used, it is an industry-changer for the good. It enables there to be a better cost structure and better quality care delivered, in this case in the health field. And, yet the health care industry hasn’t touched it, except for certain areas. And one area that has is the Veterans Administration…. And one of the reasons the Veterans Administration is doing so well in changing, kind of, behavior… is because of our Secretary, a Vietnam Vet, a really decent guy, and who is doing a fabulous job, Tony Principi.” Senior VA psychologists will recall that Secretary Principi attended the VA Psychology Leadership Conference, sponsored now by APA, Division 18, and AVAPL, during my APA Presidency.
Webinars: Ray Folen, Executive Director of the Hawaii Psychological Association (HPA): “In the mid-90’s psychologists at Tripler Army Medical Center were providing counseling and psychotherapy using inexpensive videophones that – by today’s standards – offered unimaginably low bandwidth. The video was often slow and pixelated, but it was sufficient – if barely so – to deliver needed services to those located in distant parts of the world. These early pioneering efforts demonstrated the utility and efficacy of this communications medium. Since then, of course, access to high bandwidth connectivity has increased tremendously, resulting in broad coverage and improved quality. The DOD and VA now embrace telehealth and, in particular, the use of behavioral telehealth.
“Videoconferencing for training and educational purposes has followed an evolutionary path similar to behavioral telehealth services. Compared to behavioral telehealth, though, the videoconference centers of the 90’s had greater bandwidth (still pathetically low in today’s terms). These centers were rare to find and required significant amounts of money, time and effort to operate. Videoconference sessions were highly complex events, typically requiring a dedicated videoconference room with $50K of equipment, full-time technical staff and extensive pre-session preparation. Despite all this effort, conference calls failed more often than not due to a myriad of technical problems: frozen screens, lost audio, lost connections, etc. As a result, these rooms were dark and unoccupied 95% of the time – it was simply too much trouble.
“The extraordinary changes in technology and bandwidth since that time have made videoconferencing available to just about anyone with a computer or smart device. Recently, HPA completed what may be our 100th videoconference session – an all-day in-person workshop that was simultaneously broadcast via the web to HPA members who attended the event from the comfort of their office or home. To date, 98% of our videoconference webinar workshops, presentations and meetings have been problem-free. They require a computer, a separate microphone and camera, and decent Wi-Fi connectivity. If Wi-Fi is not available, a cell phone with a ‘hot spot’ has provided an adequate Wi-Fi connection, as webinar platforms like ‘Zoom’ are very forgiving of variations in bandwidth and connectivity; audio and video quality has consistently been good.
“HPA now has highly-regarded researchers and authors giving presentations to us from all over the world. Costs are very low, given that a presentation via webinar requires no travel time or travel expenses. Almost without exception, invitations to present have received a positive response. The webinar format has become extremely popular with our members, who are now receiving excellent training in a very convenient format at very low cost.”
The National Academy of Medicine (NAM) of the National Academies of Sciences, Engineering and Medicine has developed an impressive series of webinars addressing a wide range of critical global topics. This June the Culture of Health (on which Hortensia de los Angeles Amaro, Velma McBride Murry, and I have the honor of serving) will be hosting Messaging to Advance Health Equity in Public Policy. Co-Director Ivory Clarke effectively keeps stressing to the committee the importance of the community voice – ensuring that communities are continuously brought to the table and their unique expertise elevated if policy makers want to succeed. “Health equity is crucial and health inequity is costly. Communities across the country are deploying action strategies to reduce health inequities.” Value-based messaging has proven effective in creating common ground to advance necessary change [https://nam.edu/event/messaging-to-advance-health-equity-in-public-policy/].
Under the visionary leadership of Morgan Sammons, the National Register has initiated a series of cutting-edge Clinical Webinars for health service psychologists, including this May Psychopharmacology Training and Legislation Update. “Webinars have become a quite effective vehicle for educating and disseminating valuable information to far-flung communities of psychologists. Gery Rodriguez-Menendez, Chair of the Clinical Psychopharmacology Department at the Chicago School of Professional Psychology, and I are conducting a webinar during which we will discuss the Illinois path to RxP legislative success and name the critical factors that any state could use to achieve RxP success. We will also be discussing the Illinois model of training for the prescribing psychologist that reflects our statutory requirements.
“The Chicago School of Professional Psychology is the only School, nationally, whose faculty are training psychology students, who have chosen to become prescribing psychologists, at the predoctoral level. Pursuant to the February, 2019 decision by the APA Council of Representatives to support the predoctoral training in Clinical Psychopharmacology, we expect that schools, nationwide, will begin to train predoctoral psychology students in Clinical Psychopharmacology, following our lead and that of NOVA Southeastern University, whose faculty trained predoctoral psychology students in the early 2000’s.
“Every day, I receive calls from practicing psychologists. They have decided to begin their training to become prescribing psychologists because of the dire shortages of psychiatrists and of other healthcare professionals who have competence in diagnosing mental illness and prescribing psychotropic medications. A 2015 study by Princeton University researchers found that when advanced practice nurses were granted independent prescriptive authority in their states, the suicide rate, in those states, plummeted by 12%. I believe that we will see similar statistics in the states in which we have independently prescribing psychologists” (Beth Rom-Rymer, APA Board of Directors).
Licensure Mobility: One of the most significant consequences of the growing impact of technology on the health care field is the critical importance of licensure mobility for practitioners. “PSYPACT is operational! The Psychology Interjurisdictional Compact (PSYPACT) is an interstate compact designed to facilitate the practice of tele-psychology and the temporary in-person, face-to-face practice of psychology across state boundaries. PSYPACT allows psychologists to provide electronic psychological services from their home compact state to a patient in a distant compact state without having to be licensed in the distant state. It also allows psychologists to temporarily physically go into another compact state to provide face-to-face psychological services without having to be also licensed in that distant state. Legislative action by states is needed to adopt PSYPACT into law in their state. PSYPACT became operational once seven states adopted it. Now the PSYPACT Commission will be set up to develop the bylaws and oversee PSYPACT. This commission will be made up of one delegate from each compact state.
“As of May 1st 2019, PSYPACT is alive! The following states have adopted the necessary legislation: Arizona, Utah, Nevada, Colorado, Missouri, Nebraska, Georgia, Oklahoma, and Illinois (effective January 1st 2020). There is also active legislation in Rhode Island, New Hampshire, North Carolina, Texas, the District of Columbia, and Pennsylvania. Psychologists in these states are urged to contact their own legislators to support PSYPACT. For psychologists in compact states who want to provide interjurisdictional tele-psychology services to patients in other compact states, they will have to apply for an E.Passport and for those who want to temporarily provide in person, face-to-face services in other compact states, they will have to apply for an Interjurisdictional Practice Certificate (IPC)” (Alex Siegel, asiegel@asppb.org).” Our personal congratulations to Steve DeMers, former ASPPB Executive Director; Gerald O’Brien, President); and Mariann Burnetti-Atwell, CEO for their vision and persistence in successfully implementing this very important and timely APA Council Policy. “Make me warm all over” (Don Ho). Aloha,
Pat DeLeon, former APA President – Division 42 – May, 2019
Tuesday, May 28, 2019
THIS LAND IS YOUR LAND
This spring I had the wonderful opportunity, along with our colleagues Hortensia de los Angeles Amaro and Brian Smedley, to attend the National Academy of Medicine (NAM) Culture of Health stakeholder meeting Engaging Allies in the Culture of Health Movement. The expressed objectives of this particular meeting were to discuss why Anchor Institution (such as academic health centers, hospitals, health systems, and universities) Strategies are a key component to advancing health equity and a culture of health in neighboring underserved communities; explore how to shape and use an Anchor Institution mission to advance health equity and a culture of health in communities highlighting promising models; explore how to effectively shape and use an Anchor Institution mission for businesses, non-profit foundations, and municipalities; and share information and "lessons learned" to determine a way forward in taking purposeful action through an Anchor Institution approach. Several key participants included high level representatives from Healthcare, Microsoft; Kaiser Permanente; Associations of American Universities and Academic Health Centers; Nashville Chamber of Commerce; and naturally the all-important student voice.
The Culture of Health Program is a high personal priority of NAM President Victor Dzau. It represents a multiyear collaborative effort to identify strategies to create and sustain conditions that support equitable good health for all Americans. Its four aims: Lead – identify a set of consensus study topics that build upon one another, leading to a solid knowledge base that can inform a set of actions and partnerships to advance health equity. Translate – bridge science to action for impact on health equity and optimal health for all. Engage – strengthen capacity in communities to continue to advance progress in achieving optimal health for all and inform legal, policy, and system reform. And, Sustain – transform culture in the United States to sustain progress made and to accelerate progress in areas that still have significant health disparities.
"All too often in healthcare, we ask the wrong questions, deploy the wrong resources, and are focused on the wrong solutions – and then wonder why healthcare is broken. We ask patients if they have medications, but we don't ask if they have food, heat, or a job. We provide education to patients, but we don't ask if they can read. We encourage people to lose weight, but we don't ask if they have the ability to secure healthy food…. We need to step outside our comfort zones…. We need to focus on how we can have truly significant impact on health outcomes and in our communities by addressing the root causes of health and well-being." One might reasonably ask why are organizations such as Kaiser Permante investing significant funding in communities where not all of the residents are their members? Perhaps because: "Creating a culture of health across all of its operations is not just the right thing to do, it's a smart way to get ahead of the cost curve of providing effective care, by helping create and sustain healthier communities."
Interestingly, during the discussion period several participants, including myself, "pushed back a bit" on the almost exclusive focus during the meeting of Anchoring Institutions. Federally Qualified Health Centers (FQHCs), for example, have long been stressing the importance of communities and holistic care, including the cultural-psychosocial-economic component of quality health care. Notwithstanding, "Anchor Institutions have tremendous potential to invest in communities in ways that improve social, economic, and environmental conditions that shape health. Our NAM panel highlighted innovative approaches that offer strong returns on institutional investment. I'm grateful that psychologists, such as Hortensia Amaro, are leading thinking and action in this space, for psychology offers critical insights that public health and health systems are increasingly embracing" (Brian Smedley). My personal sincerest appreciation to Co-Directors Ivory Clarke and Charlee Alexander for orchestrating a truly outstanding meeting.
An Increasingly Important Focus: As the years pass, I have become increasingly sensitive to the importance of each of the health professions learning from the wisdom of those they elected to be their national Presidents. That experience gives one a unique perspective – on the potential unique contributions of their own profession and equally important, the nation's ever-evolving global environment. Former APA President Susan McDaniel stressed the importance of interprofessional collaboration, especially during the formative graduate school experiences. Alan Kazdin emphasized the importance of seeking to serve those that simply do not have access to any health care: "e.g., children, older individuals, single parents, individuals of ethnicity, victims of violence, and it goes on." I vividly recall my discussions with Seymour Sarason during his final years in an extended care facility where many of his Yale colleagues would eventually retire. He wished that he had been aware of the way that our nation's elderly were "treated" so that he could have addressed this during his nearly half a century on the Yale psychology faculty. On the island of Lana'i visionary colleagues are making a lasting difference.
"Lana'i Community Health Center's (LCHC) Behavioral Health Program started with our involvement in a Federal Training grant in 2012. Being a small remote, rural federally qualified health center (FQCHC) we were thrilled to be a part of this grant – but mostly we were thrilled to offer Behavioral Health (BH) psychology services to our community. The island of Lana'i is one of the smallest of the inhabited Hawaiian islands – its population is 3,100, with mostly Filipino residents who originally relocated to work in the pineapple fields. Health care of any sort is limited: there is a small critical care access hospital with the ability to treat and release or send out to the other larger islands, our FQCHC, one small private practice medical provider, and a small private practice dental office. Our organization is the only location where BH services are provided to all in need and the only place on island to offer such services on a sliding fee scale. From the first LCHC training grant fellows, to Cori Takesue, the first FTE Post-doc fellow hired with non-grant funds, we now have 2.5 FTEs. All post-docs are in the process of securing their license, and at least 2 FTE will hopefully remain with us. LCHC and its providers have worked hard to remove the stigma of seeking BH services, to be accepted and trusted by our community members. Our success can be seen by the growth in our patient numbers… and the growth in our wait list.
"What is also clear is that in our community it is not the opioid crisis that is affecting many areas of nation; it is depression, anxiety, stress, alcohol, and smoking that are bringing people to our doorstep. It is the stress of trying to make ends meet on an island where cost of living clearly outpaces salary. It is the depression and stress associated with feeling as if you are failing your family. So we continue to see the need grow. LCHC has been recruiting for a third FTE… for over two years. We will accept post-docs or licensed providers – however, due to the severe shortage of candidates, combined with the rural, remote nature of our community, we have continually fallen short of our recruitment goal. Our most likely candidates – those who are willing to work and live on our island – are those who have ties in Hawaii. Even better, if they intern with us for a year. Our main feeder has been Argosy with its connections to I Ola Lahui (a Native Hawaiian initiative, established by psychology) and their training program.
"We have successfully integrated all our services (medical, dental, and vision) with behavioral health – knowing that the key to wellness is a holistic approach. We utilize telemedicine for psychiatry, as well as a number of our specialty medical programs; however, for the basic day-to-day support we find that it is best if we have individuals living and working on our island. It is better for our patients who create a sound base of trust, and it is better for our providers who interact with all disciplines to ensure the holistic approach is being utilized. But now what? Sadly, we have the funds to support additional hires but no candidates to hire. Isn't one of the roles of government to step in and provide workable solutions and oversight to protect harm to the individual? Clearly, in my opinion, government has failed – at least to this point.
"But all is not lost. Some programs and efforts show signs of recognition of needs and response. Under the leadership of former USPHS chief nurse, Dean Carol Romano, the Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University (USU) has placed DNP graduate students with us. U.S. Navy LCDR Kayla R. Horton and U.S. Army MAJ Margaret Martin interned last year, sharpening their skills as a future APRN in rural, remote, and diverse settings. This partnership with USU brings a shared opportunity for learning and new experiences. Their experiences provided them with access to a full range of family practice issues, home visits, participation in LCHC's school-based education program, and the use of telemedicine – especially for services that are uncommon in the military – including surviving a hurricane on a small austere island. They were exposed to the cultural diversity of Lana'i's community, which will add enhanced cultural sensitivity to their arsenal of health care tools. Overall, by allowing faculty and students to participate in LCHC's activities and live within our community, this joint effort and our combined resources works to develop, improve, and sustain the delivery of outstanding medical, dental, nursing, and clinical care and preventive medicine.
"The relationship that LCHC has forged with USU and other teaching programs has proven to be critical both to future health care providers as well as to LCHC's workforce development. One of our main goals is role model development. With the current nurse and health care provider shortage in the United States, and more notably in rural areas such as Lana'i, these select students are able to go into the community and educate school age children on a career in nursing and/or as a nurse practitioner. These intimate interactions may also attract young people into the military nursing and medicine fields. We saw the potential to inspire the next generation of Lanai's citizens in seeking nursing as a career and coming back to serve in our community.
"Additionally, these rotations benefits students in numerous ways, such as teaching critical thinking skills needed to practice in remote austere settings, gaining a greater appreciation for cultural diversity, and exposure to systems thinking outside of the Military Treatment Facility. A similar nursing program for Behavioral Health is needed – one that will be beneficial to both participants and will result in a larger applicant pool with rural health experience. Courage is needed on the part of the government to take this next step… not just leaving health care organizations like LCHC without the ability to address these pressing behavioral needs" (Diana Shaw, LCHC Executive Director).
RxP – The Maturing Agenda: Under Morgan Sammons' stewardship the National Register has done an outstanding job representing the interests of psychology's practitioners and particularly in educating them regarding the unprecedented changes occurring within the nation's health care environment. For example, the Register will be sponsoring an RxP Webinar providing an update on Training and Legislation, featuring APA Board Member Beth Rom-Rymer and her colleague Gerardo Rodriguez-Menendez from the Chicago School of Professional Psychology. "This land was made for you and me" (Woody Guthrie). Aloha,
Pat DeLeon, former APA President – Division 29 – May, 2019
Sent from my iPhone
The Culture of Health Program is a high personal priority of NAM President Victor Dzau. It represents a multiyear collaborative effort to identify strategies to create and sustain conditions that support equitable good health for all Americans. Its four aims: Lead – identify a set of consensus study topics that build upon one another, leading to a solid knowledge base that can inform a set of actions and partnerships to advance health equity. Translate – bridge science to action for impact on health equity and optimal health for all. Engage – strengthen capacity in communities to continue to advance progress in achieving optimal health for all and inform legal, policy, and system reform. And, Sustain – transform culture in the United States to sustain progress made and to accelerate progress in areas that still have significant health disparities.
"All too often in healthcare, we ask the wrong questions, deploy the wrong resources, and are focused on the wrong solutions – and then wonder why healthcare is broken. We ask patients if they have medications, but we don't ask if they have food, heat, or a job. We provide education to patients, but we don't ask if they can read. We encourage people to lose weight, but we don't ask if they have the ability to secure healthy food…. We need to step outside our comfort zones…. We need to focus on how we can have truly significant impact on health outcomes and in our communities by addressing the root causes of health and well-being." One might reasonably ask why are organizations such as Kaiser Permante investing significant funding in communities where not all of the residents are their members? Perhaps because: "Creating a culture of health across all of its operations is not just the right thing to do, it's a smart way to get ahead of the cost curve of providing effective care, by helping create and sustain healthier communities."
Interestingly, during the discussion period several participants, including myself, "pushed back a bit" on the almost exclusive focus during the meeting of Anchoring Institutions. Federally Qualified Health Centers (FQHCs), for example, have long been stressing the importance of communities and holistic care, including the cultural-psychosocial-economic component of quality health care. Notwithstanding, "Anchor Institutions have tremendous potential to invest in communities in ways that improve social, economic, and environmental conditions that shape health. Our NAM panel highlighted innovative approaches that offer strong returns on institutional investment. I'm grateful that psychologists, such as Hortensia Amaro, are leading thinking and action in this space, for psychology offers critical insights that public health and health systems are increasingly embracing" (Brian Smedley). My personal sincerest appreciation to Co-Directors Ivory Clarke and Charlee Alexander for orchestrating a truly outstanding meeting.
An Increasingly Important Focus: As the years pass, I have become increasingly sensitive to the importance of each of the health professions learning from the wisdom of those they elected to be their national Presidents. That experience gives one a unique perspective – on the potential unique contributions of their own profession and equally important, the nation's ever-evolving global environment. Former APA President Susan McDaniel stressed the importance of interprofessional collaboration, especially during the formative graduate school experiences. Alan Kazdin emphasized the importance of seeking to serve those that simply do not have access to any health care: "e.g., children, older individuals, single parents, individuals of ethnicity, victims of violence, and it goes on." I vividly recall my discussions with Seymour Sarason during his final years in an extended care facility where many of his Yale colleagues would eventually retire. He wished that he had been aware of the way that our nation's elderly were "treated" so that he could have addressed this during his nearly half a century on the Yale psychology faculty. On the island of Lana'i visionary colleagues are making a lasting difference.
"Lana'i Community Health Center's (LCHC) Behavioral Health Program started with our involvement in a Federal Training grant in 2012. Being a small remote, rural federally qualified health center (FQCHC) we were thrilled to be a part of this grant – but mostly we were thrilled to offer Behavioral Health (BH) psychology services to our community. The island of Lana'i is one of the smallest of the inhabited Hawaiian islands – its population is 3,100, with mostly Filipino residents who originally relocated to work in the pineapple fields. Health care of any sort is limited: there is a small critical care access hospital with the ability to treat and release or send out to the other larger islands, our FQCHC, one small private practice medical provider, and a small private practice dental office. Our organization is the only location where BH services are provided to all in need and the only place on island to offer such services on a sliding fee scale. From the first LCHC training grant fellows, to Cori Takesue, the first FTE Post-doc fellow hired with non-grant funds, we now have 2.5 FTEs. All post-docs are in the process of securing their license, and at least 2 FTE will hopefully remain with us. LCHC and its providers have worked hard to remove the stigma of seeking BH services, to be accepted and trusted by our community members. Our success can be seen by the growth in our patient numbers… and the growth in our wait list.
"What is also clear is that in our community it is not the opioid crisis that is affecting many areas of nation; it is depression, anxiety, stress, alcohol, and smoking that are bringing people to our doorstep. It is the stress of trying to make ends meet on an island where cost of living clearly outpaces salary. It is the depression and stress associated with feeling as if you are failing your family. So we continue to see the need grow. LCHC has been recruiting for a third FTE… for over two years. We will accept post-docs or licensed providers – however, due to the severe shortage of candidates, combined with the rural, remote nature of our community, we have continually fallen short of our recruitment goal. Our most likely candidates – those who are willing to work and live on our island – are those who have ties in Hawaii. Even better, if they intern with us for a year. Our main feeder has been Argosy with its connections to I Ola Lahui (a Native Hawaiian initiative, established by psychology) and their training program.
"We have successfully integrated all our services (medical, dental, and vision) with behavioral health – knowing that the key to wellness is a holistic approach. We utilize telemedicine for psychiatry, as well as a number of our specialty medical programs; however, for the basic day-to-day support we find that it is best if we have individuals living and working on our island. It is better for our patients who create a sound base of trust, and it is better for our providers who interact with all disciplines to ensure the holistic approach is being utilized. But now what? Sadly, we have the funds to support additional hires but no candidates to hire. Isn't one of the roles of government to step in and provide workable solutions and oversight to protect harm to the individual? Clearly, in my opinion, government has failed – at least to this point.
"But all is not lost. Some programs and efforts show signs of recognition of needs and response. Under the leadership of former USPHS chief nurse, Dean Carol Romano, the Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University (USU) has placed DNP graduate students with us. U.S. Navy LCDR Kayla R. Horton and U.S. Army MAJ Margaret Martin interned last year, sharpening their skills as a future APRN in rural, remote, and diverse settings. This partnership with USU brings a shared opportunity for learning and new experiences. Their experiences provided them with access to a full range of family practice issues, home visits, participation in LCHC's school-based education program, and the use of telemedicine – especially for services that are uncommon in the military – including surviving a hurricane on a small austere island. They were exposed to the cultural diversity of Lana'i's community, which will add enhanced cultural sensitivity to their arsenal of health care tools. Overall, by allowing faculty and students to participate in LCHC's activities and live within our community, this joint effort and our combined resources works to develop, improve, and sustain the delivery of outstanding medical, dental, nursing, and clinical care and preventive medicine.
"The relationship that LCHC has forged with USU and other teaching programs has proven to be critical both to future health care providers as well as to LCHC's workforce development. One of our main goals is role model development. With the current nurse and health care provider shortage in the United States, and more notably in rural areas such as Lana'i, these select students are able to go into the community and educate school age children on a career in nursing and/or as a nurse practitioner. These intimate interactions may also attract young people into the military nursing and medicine fields. We saw the potential to inspire the next generation of Lanai's citizens in seeking nursing as a career and coming back to serve in our community.
"Additionally, these rotations benefits students in numerous ways, such as teaching critical thinking skills needed to practice in remote austere settings, gaining a greater appreciation for cultural diversity, and exposure to systems thinking outside of the Military Treatment Facility. A similar nursing program for Behavioral Health is needed – one that will be beneficial to both participants and will result in a larger applicant pool with rural health experience. Courage is needed on the part of the government to take this next step… not just leaving health care organizations like LCHC without the ability to address these pressing behavioral needs" (Diana Shaw, LCHC Executive Director).
RxP – The Maturing Agenda: Under Morgan Sammons' stewardship the National Register has done an outstanding job representing the interests of psychology's practitioners and particularly in educating them regarding the unprecedented changes occurring within the nation's health care environment. For example, the Register will be sponsoring an RxP Webinar providing an update on Training and Legislation, featuring APA Board Member Beth Rom-Rymer and her colleague Gerardo Rodriguez-Menendez from the Chicago School of Professional Psychology. "This land was made for you and me" (Woody Guthrie). Aloha,
Pat DeLeon, former APA President – Division 29 – May, 2019
Sent from my iPhone
Monday, May 27, 2019
ALOHA - D29
“THIS LAND IS YOUR LAND”
This spring I had the wonderful opportunity, along with our colleagues Hortensia de los Angeles Amaro and Brian Smedley, to attend the National Academy of Medicine (NAM) Culture of Health stakeholder meeting Engaging Allies in the Culture of Health Movement. The expressed objectives of this particular meeting were to discuss why Anchor Institution (such as academic health centers, hospitals, health systems, and universities) Strategies are a key component to advancing health equity and a culture of health in neighboring underserved communities; explore how to shape and use an Anchor Institution mission to advance health equity and a culture of health in communities highlighting promising models; explore how to effectively shape and use an Anchor Institution mission for businesses, non-profit foundations, and municipalities; and share information and “lessons learned” to determine a way forward in taking purposeful action through an Anchor Institution approach. Several key participants included high level representatives from Healthcare, Microsoft; Kaiser Permanente; Associations of American Universities and Academic Health Centers; Nashville Chamber of Commerce; and naturally the all-important student voice.
The Culture of Health Program is a high personal priority of NAM President Victor Dzau. It represents a multiyear collaborative effort to identify strategies to create and sustain conditions that support equitable good health for all Americans. Its four aims: Lead – identify a set of consensus study topics that build upon one another, leading to a solid knowledge base that can inform a set of actions and partnerships to advance health equity. Translate – bridge science to action for impact on health equity and optimal health for all. Engage – strengthen capacity in communities to continue to advance progress in achieving optimal health for all and inform legal, policy, and system reform. And, Sustain – transform culture in the United States to sustain progress made and to accelerate progress in areas that still have significant health disparities.
“All too often in healthcare, we ask the wrong questions, deploy the wrong resources, and are focused on the wrong solutions – and then wonder why healthcare is broken. We ask patients if they have medications, but we don’t ask if they have food, heat, or a job. We provide education to patients, but we don’t ask if they can read. We encourage people to lose weight, but we don’t ask if they have the ability to secure healthy food…. We need to step outside our comfort zones…. We need to focus on how we can have truly significant impact on health outcomes and in our communities by addressing the root causes of health and well-being.” One might reasonably ask why are organizations such as Kaiser Permante investing significant funding in communities where not all of the residents are their members? Perhaps because: “Creating a culture of health across all of its operations is not just the right thing to do, it’s a smart way to get ahead of the cost curve of providing effective care, by helping create and sustain healthier communities.”
Interestingly, during the discussion period several participants, including myself, “pushed back a bit” on the almost exclusive focus during the meeting of Anchoring Institutions. Federally Qualified Health Centers (FQHCs), for example, have long been stressing the importance of communities and holistic care, including the cultural-psychosocial-economic component of quality health care. Notwithstanding, “Anchor Institutions have tremendous potential to invest in communities in ways that improve social, economic, and environmental conditions that shape health. Our NAM panel highlighted innovative approaches that offer strong returns on institutional investment. I’m grateful that psychologists, such as Hortensia Amaro, are leading thinking and action in this space, for psychology offers critical insights that public health and health systems are increasingly embracing” (Brian Smedley). My personal sincerest appreciation to Co-Directors Ivory Clarke and Charlee Alexander for orchestrating a truly outstanding meeting.
An Increasingly Important Focus: As the years pass, I have become increasingly sensitive to the importance of each of the health professions learning from the wisdom of those they elected to be their national Presidents. That experience gives one a unique perspective – on the potential unique contributions of their own profession and equally important, the nation’s ever-evolving global environment. Former APA President Susan McDaniel stressed the importance of interprofessional collaboration, especially during the formative graduate school experiences. Alan Kazdin emphasized the importance of seeking to serve those that simply do not have access to any health care: “e.g., children, older individuals, single parents, individuals of ethnicity, victims of violence, and it goes on.” I vividly recall my discussions with Seymour Sarason during his final years in an extended care facility where many of his Yale colleagues would eventually retire. He wished that he had been aware of the way that our nation’s elderly were “treated” so that he could have addressed this during his nearly half a century on the Yale psychology faculty. On the island of Lana’i visionary colleagues are making a lasting difference.
“Lana’i Community Health Center’s (LCHC) Behavioral Health Program started with our involvement in a Federal Training grant in 2012. Being a small remote, rural federally qualified health center (FQCHC) we were thrilled to be a part of this grant – but mostly we were thrilled to offer Behavioral Health (BH) psychology services to our community. The island of Lana’i is one of the smallest of the inhabited Hawaiian islands – its population is 3,100, with mostly Filipino residents who originally relocated to work in the pineapple fields. Health care of any sort is limited: there is a small critical care access hospital with the ability to treat and release or send out to the other larger islands, our FQCHC, one small private practice medical provider, and a small private practice dental office. Our organization is the only location where BH services are provided to all in need and the only place on island to offer such services on a sliding fee scale. From the first LCHC training grant fellows, to Cori Takesue, the first FTE Post-doc fellow hired with non-grant funds, we now have 2.5 FTEs. All post-docs are in the process of securing their license, and at least 2 FTE will hopefully remain with us. LCHC and its providers have worked hard to remove the stigma of seeking BH services, to be accepted and trusted by our community members. Our success can be seen by the growth in our patient numbers… and the growth in our wait list.
“What is also clear is that in our community it is not the opioid crisis that is affecting many areas of nation; it is depression, anxiety, stress, alcohol, and smoking that are bringing people to our doorstep. It is the stress of trying to make ends meet on an island where cost of living clearly outpaces salary. It is the depression and stress associated with feeling as if you are failing your family. So we continue to see the need grow. LCHC has been recruiting for a third FTE… for over two years. We will accept post-docs or licensed providers – however, due to the severe shortage of candidates, combined with the rural, remote nature of our community, we have continually fallen short of our recruitment goal. Our most likely candidates – those who are willing to work and live on our island – are those who have ties in Hawaii. Even better, if they intern with us for a year. Our main feeder has been Argosy with its connections to I Ola Lahui (a Native Hawaiian initiative, established by psychology) and their training program.
“We have successfully integrated all our services (medical, dental, and vision) with behavioral health – knowing that the key to wellness is a holistic approach. We utilize telemedicine for psychiatry, as well as a number of our specialty medical programs; however, for the basic day-to-day support we find that it is best if we have individuals living and working on our island. It is better for our patients who create a sound base of trust, and it is better for our providers who interact with all disciplines to ensure the holistic approach is being utilized. But now what? Sadly, we have the funds to support additional hires but no candidates to hire. Isn’t one of the roles of government to step in and provide workable solutions and oversight to protect harm to the individual? Clearly, in my opinion, government has failed – at least to this point.
“But all is not lost. Some programs and efforts show signs of recognition of needs and response. Under the leadership of former USPHS chief nurse, Dean Carol Romano, the Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University (USU) has placed DNP graduate students with us. U.S. Navy LCDR Kayla R. Horton and U.S. Army MAJ Margaret Martin interned last year, sharpening their skills as a future APRN in rural, remote, and diverse settings. This partnership with USU brings a shared opportunity for learning and new experiences. Their experiences provided them with access to a full range of family practice issues, home visits, participation in LCHC’s school-based education program, and the use of telemedicine – especially for services that are uncommon in the military – including surviving a hurricane on a small austere island. They were exposed to the cultural diversity of Lana’i’s community, which will add enhanced cultural sensitivity to their arsenal of health care tools. Overall, by allowing faculty and students to participate in LCHC’s activities and live within our community, this joint effort and our combined resources works to develop, improve, and sustain the delivery of outstanding medical, dental, nursing, and clinical care and preventive medicine.
“The relationship that LCHC has forged with USU and other teaching programs has proven to be critical both to future health care providers as well as to LCHC’s workforce development. One of our main goals is role model development. With the current nurse and health care provider shortage in the United States, and more notably in rural areas such as Lana’i, these select students are able to go into the community and educate school age children on a career in nursing and/or as a nurse practitioner. These intimate interactions may also attract young people into the military nursing and medicine fields. We saw the potential to inspire the next generation of Lanai’s citizens in seeking nursing as a career and coming back to serve in our community.
“Additionally, these rotations benefits students in numerous ways, such as teaching critical thinking skills needed to practice in remote austere settings, gaining a greater appreciation for cultural diversity, and exposure to systems thinking outside of the Military Treatment Facility. A similar nursing program for Behavioral Health is needed – one that will be beneficial to both participants and will result in a larger applicant pool with rural health experience. Courage is needed on the part of the government to take this next step… not just leaving health care organizations like LCHC without the ability to address these pressing behavioral needs” (Diana Shaw, LCHC Executive Director).
RxP – The Maturing Agenda: Under Morgan Sammons’ stewardship the National Register has done an outstanding job representing the interests of psychology’s practitioners and particularly in educating them regarding the unprecedented changes occurring within the nation’s health care environment. For example, the Register will be sponsoring an RxP Webinar providing an update on Training and Legislation, featuring APA Board Member Beth Rom-Rymer and her colleague Gerardo Rodriguez-Menendez from the Chicago School of Professional Psychology. “This land was made for you and me” (Woody Guthrie). Aloha,
Pat DeLeon, former APA President – Division 29 – May, 2019
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