LAND OF 10.000 LAKES AND EXCEPTIONAL VISION

 Having the 121^st Annual APA Convention in Honolulu, Hawaii was extraordinarily memorable for the 11,400 registrants and HPA.  The vision, vitality, and enthusiasm of the next generation were infectious.  From a health policy perspective, it was especially gratifying to see the extent to which new career psychologists and graduate students were actively embracing the notion of integrated, patient-centered care which is the hallmark of President Obama's landmark Patient Protection and Affordable Care Act (ACA).  Unprecedented change, driven primarily by historically escalating costs and a new appreciation for the potential contribution of the advances occurring in communications technology (i.e., electronic health records, comparative effectiveness research, and telehealth), is rapidly impacting the nation's healthcare environment.  Cynthia Belar described how from the APA Education Directorate's vantage point, psychology's training institutions and internship sites are successfully adapting to the changing demands of the 21^st century.  Personally, one of the most gratifying presentations at the convention was the symposium chaired by Patti Johnson, who has now served in the U.S. Army for over 20 years, addressing the unique psycho-social needs of military families and especially their children.  The nation's protracted conflicts have had a significant impact upon the behavioral health of military children and youth.  Patti's panel discussed a number of innovative programs that were making a real difference.  All of psychology owes President Don Bersoff our gratitude for his vision and passion in developing special Presidential programmatic initiatives focusing upon how psychology can contribute to the nation's responsibility for our Wounded Warriors and their families.

            I currently have the opportunity of serving at the Uniformed Services University of the Health Sciences (USUHS) (DoD) where psychology and nursing have made a special, and in my judgment visionary, commitment to fostering true interdisciplinary training.  "As a graduate student in the clinical psychology doctoral program at USUHS, I study alongside advanced nursing students.  Participating in interdisciplinary classes has taught me that psychology and nursing share similar goals and pursue complementary research questions.  When looking for allies to improve the health care of our warriors and our nation, nurses and psychologists have to look no further than to each other.  And, by collaborating in our formative years, we maximize our impact as team-based healthcare providers (Joanna Sells)."

A Breath of Populism:  During the nearly four decades that I had the honor of working for U.S. Senator Daniel K. Inouye, I found that his colleagues from Minnesota were truly inspirational in their commitment to providing high quality health care for all Americans.  In the early days, right across the corridor was the office of Senator Walter Mondale – a definite friend of psychology.  Senator Hubert Humphrey, who was eventually honored by having the headquarters of the Department of Health and Human Services named after him, was forever actively engaged in numerous policy debates.  Senator David Durenberger, in his Senate Finance Committee capacity, was a visionary in fostering comprehensive bipartisan health care initiatives – perhaps, having seen first-hand the extraordinary accomplishments of the world-renown Mayo Clinic.

The Wellstone Legacy:  Those of us who choose careers in psychology and thereby learn to appreciate the value of the behavioral sciences owe so much to Senator Paul Wellstone, who worked tirelessly across the political aisle with Senator Pete Domenici to enact their far reaching Mental Health Parity legislation.  This effort ultimately led to the critical integration of mental (behavioral) health care into the mainstream of primary care as envisioned in the President's ACA.  Over the years there has been much discussion regarding the unfortunate stigma associated with receiving mental health treatment.  Ken Pope recently shared that change may finally be coming.  Mental health and substance addiction treatment has long been the stepchild of our health care system.  However in 2009, public and private mental health spending totaled approximately $150 billion, more than double its level in inflation-adjusted terms in 1986.  The ACA will provide the largest expansion of mental health and substance use disorder coverage in a generation, with 32.1 million Americans gaining access to these services, while another 30.4 million currently with some coverage will gain federal parity protection.  This Fall, the Military Officers Association of America and the National Defense Industrial Association hosted their 2013 Warrior-Family Symposium "Mental Health: Linking Warriors and Their Families, Government and Society."  The program took a broad look at mental health and the challenges ahead, particularly in a post-war environment.  They addressed: * What is the scope of mental health among our military members, veterans, and their families?  * What are the mental health implications to individuals, government, and society?  And, * What are some of the innovative solutions taking place in the mental health field?  This is a call-to-action on ways that individuals and organizations can affect change to help warriors-families today and tomorrow.  When I arrived on Capitol Hill, on the first day of the infamous Watergate hearings, such a public discussion of mental health issues would have been unheard of.  The efforts of Senator Wellstone and his colleagues have made a real difference.  Mahalo.

RxP – An Evolution:  There were also a number of exciting presentations in Hawaii addressing the maturation of psychology's prescriptive authority (RxP) agenda, which directly relates to the profession demonstrating a "value-add" contribution (citing Katherine Nordal) within integrative healthcare delivery systems.  Bob McGrath, who directs the Fairleigh Dickinson University RxP training program, estimates that 60 percent of the mental health medications prescribed today are ordered by primary care providers who possess considerably less mental/behavioral health training than psychologists or advanced practice mental health nurses.  Illinois's Beth Rom-Rymer coordinated a number of these visionary programs and noted the importance of remembering those who demonstrated vision long before their cause became popular.  "I very much appreciate the emphasis on RxP in our federal systems.  Bob Ax, Randy Taylor, and Kathy McNamara deserve commendation for initiating the conversation about opening up the federal agencies to RxP and keeping these conversations in the forefront of our intentions.  It was Bob and Randy who put out the RFP in 2007 for psychopharm training programs to offer scholarships to psychologists in public service venues who wanted to be RxP trained.  And, then, it was Steve Tulkin who was awarded the opportunity to search for major gifts so that Alliant/CSPP could train these 100 public service psychologists.  Alliant/CSPP has now trained about 50 public service psychologists.  I'm certain that more psychologists will want to be trained when we have additional states and federal agencies hiring RxP psychologists.  As we know, there is a desperate need for RxP in the VA as well as in the prison system."  Over my years of involvement within the public policy process, I have come to appreciate that those with vision and persistence do extraordinarily well in our evolving health care environment.  Aloha,

 

Pat DeLeon, former APA President – Minnesota Psychological Association – September, 2013

TIME FOR ACTION

            State Public Sector Initiatives:  Over the years that we have been involved with the prescriptive authority agenda (RxP), there has been remarkably little discussion regarding the possibility of colleagues working within State prison and mental health systems providing this important clinical service.  Fred Frese, a longtime advocate for psychology's increased involvement with individuals challenged by chronic mental health issues, recently reported on a 7-year follow-up study published in JAMA-Psychiatry finding that individuals with schizophrenia who are on reduced or no doses of anti-psychotic medications do better than those on medications.  Other research Fred has highlighted suggests that those on antipsychotic medications live 15 to 25 years less than would be normally expected.  As is the case with colleagues serving within federal institutions (i.e., the Department of Defense (DoD), Indian Health Service (IHS), and Department of Veterans Affairs (VA)), legislative restrictions on scope of practice issues frequently do not apply to public employees.  We understand from Glenn Ally that since the enactment of their RxP legislation on May 6, 2004, medical psychologists in Louisiana have had an increasing presence within their public mental health system.  Given the impressive and lengthy history of federal colleagues prescribing, we would hope that fostering state-based pilot projects would become a legislative priority for our State Associations.

 

During our recent Hawaii convention, we were very pleased to receive an update from Illinois RxP proponent Beth Rom-Rymer that in Ohio: "While, originally the Ohio RxP bill had been introduced as a small-scale demonstration project focusing upon the needs of the criminal justice system, legislative sponsors have urged us to introduce a full-scale RxP bill.  This bill will be introduced in the 2014 legislative session, with a promise of doing well (Michael Ranney)."  Those familiar with nursing's successful RxP quest over the years will appreciate the pivotal role that a small demonstration project in Ohio (when then-Dean Ron Fox was at Wright State University) evolved into a national success.

 

A New Era for Behavioral Health:  President Obama's Patient Protection and Affordable Care Act (ACA) provides the states with considerable flexibility to implement a program that is tailored to their unique needs and strengths.  Notwithstanding the current political climate, the political/policy experts that I am aware of do not seriously think that the ACA will be repealed or the newest phrase "unfunded."  Unprecedented change has come to our nation's health care system with an emphasis upon integrated, interdisciplinary, patient-centered care, utilizing communications technology to objectively develop data-based "gold standard" protocols.  The Administration has given a high priority to ensuring parity between mental health care and traditional physical health care, demonstrated by mental health and substance abuse services being among the ten "essential benefits" health insurers must provide under the state health exchange provision of ACA, which is to be implemented October 1, 2013.  Aloha,

 

Pat DeLeon, former APA President – Division 31 – September, 2013

TIME FOR ACTION

     State Public Sector Initiatives:  Over the years that we have been involved with the prescriptive authority agenda (RxP), there has been remarkably little discussion regarding the possibility of colleagues working within State prison and mental health systems providing this important clinical service.  Fred Frese, a longtime advocate for psychology's increased involvement with individuals challenged by chronic mental health issues, recently reported on a 7-year follow-up study published in JAMA-Psychiatry finding that individuals with schizophrenia who are on reduced or no doses of anti-psychotic medications do better than those on medications.  Other research Fred has highlighted suggests that those on antipsychotic medications live 15 to 25 years less than would be normally expected.  As is the case with colleagues serving within federal institutions (i.e., the Department of Defense (DoD), Indian Health Service (IHS), and Department of Veterans Affairs (VA)), legislative restrictions on scope of practice issues frequently do not apply to public employees.  We understand from Glenn Ally that since the enactment of their RxP legislation on May 6, 2004, medical psychologists in Louisiana have had an increasing presence within their public mental health system.  Given the impressive and lengthy history of federal colleagues prescribing, we would hope that fostering state-based pilot projects would become a legislative priority for our State Associations.

During our recent Hawaii convention, we were very pleased to receive an update from Illinois RxP proponent Beth Rom-Rymer that in Ohio: "While, originally the Ohio RxP bill had been introduced as a small-scale demonstration project focusing upon the needs of the criminal justice system, legislative sponsors have urged us to introduce a full-scale RxP bill.  This bill will be introduced in the 2014 legislative session, with a promise of doing well (Michael Ranney)."  Those familiar with nursing's successful RxP quest over the years will appreciate the pivotal role that a small demonstration project in Ohio (when then-Dean Ron Fox was at Wright State University) evolved into a national success.

A New Era for Behavioral Health:  President Obama's Patient Protection and Affordable Care Act (ACA) provides the states with considerable flexibility to implement a program that is tailored to their unique needs and strengths.  Notwithstanding the current political climate, the political/policy experts that I am aware of do not seriously think that the ACA will be repealed or the newest phrase "unfunded."  Unprecedented change has come to our nation's health care system with an emphasis upon integrated, interdisciplinary, patient-centered care, utilizing communications technology to objectively develop data-based "gold standard" protocols.  The Administration has given a high priority to ensuring parity between mental health care and traditional physical health care, demonstrated by mental health and substance abuse services being among the ten "essential benefits" health insurers must provide under the state health exchange provision of ACA, which is to be implemented October 1, 2013.  Aloha,

Pat DeLeon, former APA President – Division 31 – September, 2013

LAND OF THE DINOSAURS ?

 Attending the annual APA convention has always been an exciting event -- seeing old friends, experiencing the enthusiasm of the next generation, and learning about new challenges.  This has definitely become "my gift to myself."  This year our 121st gathering was truly special, joining approximately 11,400 colleagues in Honolulu, Hawaii – home of psychology's first prescriptive authority (RxP) legislation.  One of the most memorable highlights was attending HPA's welcoming reception with former HPA President June Ching at the beautiful home of another former HPA President Tanya D'Avanzo, overlooking the ocean on the Windward side of Oahu.  Hawaii is truly special in so many ways.  APA President Don Bersoff, as well as a number of the Board of Directors, was able to attend.  Those of us who have decided to pursue careers in psychology are very fortunate – respected by society and possessing "interesting lives."  Accordingly, we have a special obligation to "give back to society."  Those who were fortunate to attend Don's Opening Ceremony not only were charmed by HPA President Darryl Salvador's Aloha greeting, they also were provided the opportunity to reflect upon how psychologists such as Jon Nachison (Stand Down), Toni Zeiss (VA), and Barbara Van Dahlen (Give an Hour) have lived a meaningful portion of their lives through public service, dedicated to improving the lives of those who have served our nation over the decades; i.e., Wounded Warriors and their families.  The inspiring Presidential programmatic initiatives, which were held throughout the convention, focused upon the resilience and the unique and pressing needs of military families, their loved ones, and those continuing to serve the nation with distinction.  Over the years, we have learned that the essence of all of the "learned professions" is possessing the vision and the willingness to seek a higher purpose – psychology is no exception.

            Since U.S. Senator Daniel K. Inouye called upon HPA to seek prescriptive authority in the fall of 1984, in order to better serve their clients, organized psychology has slowly but steadily advanced this legislative/clinical agenda.  In 1989 the Board of Professional Affairs (BPA) held a special retreat on this topic under the chairpersonship of Norma Simon.  And in 1995 the APA Council of Representatives formally endorsed obtaining prescriptive authority as APA Policy.  As a result of Senator Inouye's leadership during the Fiscal Year 1989 Department of Defense (DoD) Appropriations process, psychologists are prescribing today within DoD and the U.S. Public Health Service, as well as colleagues in Louisiana and New Mexico with John Bolter and Elaine LeVine being the first and first female outside of the federal sector legally prescribing.  Few appreciate, however, that both Indiana (1993) and Guam (1998) have also enacted authorization legislation although not implemented to date.

From our global health policy perspective, especially with the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA), we fully expect that those who are comfortable with the present (regardless of their professional discipline and years of training) will soon find themselves obsolete.  Psychology and the behavioral sciences have much to offer to our nation's health care delivery system, but only if we collectively get involved in the public policy/political process.  As APA's Katherine Nordal graphically described at this year's impressive State Leadership Conference: "We're facing uncharted territory with health care reform, and there's no universal roadmap to guide us.  The details of ACA implementation vary from state to state, and so do the key players.   Our practitioners increasingly will need to promote the value and quality they can contribute to emerging models of care.  I believe that if we are not valued as a health profession, it will detract from our value in other practice arenas as well.  No one else is fighting the battles for psychology and don't expect them to.  Health care reform is a marathon – we're in it for the long haul.  New models of care and changes in health care financing won't take shape overnight.  We can't hope to finish the marathon called health care reform if we're not at the starting line.  Fortunately, many psychology leaders have embraced our call to action."  And a year earlier: "If we're not at the table, it's because we're on the menu.  And I quite frankly don't want to be on anybody's plate to be eaten."  Katherine also pointed out that psychologists make up only about one-sixth of the behavioral health workforce.  Thus, with general practice physicians consistently prescribing 60% of the psychotropic medications, RxP provides a real opportunity to demonstrate "value-add" to the health care systems of the future.

A Visionary RxP Trainer's Perspective:  Bob McGrath, who administers the Fairleigh Dickinson University (FDU) RxP training program, reports that: "We were saying 1600 colleagues have already completed their training a year ago.  Today I expect we are up to about 1750.  The pursuit of prescriptive authority in Illinois and New Jersey has resulted in an unexpected but exciting by-product, which is a dramatic increase in enrollments to the FDU psychopharm masters' program.  I'm pleased to say that we are about to start our largest class ever.  Even the possibility of passage in a more industrialized state has revealed a continued and even perhaps growing interest in psychopharm training.  I continue to believe we can only combat the mismanagement of medication – both its underuse AND overuse – if we can manage it ourselves.  I also maintain my belief that RxP should be the #1 advocacy agenda for the profession.  While other agenda items such as parity or identification as 'physicians' increase the potential for others to hire psychologists, only RxP enhances the motivation for others to hire psychologists.  Unfortunately, for too long a small group of naysayers have dominated the discussion.  I think it's time for us to celebrate the remarkable contributions of our prescribing psychologists, including a 20-year history without a single complaint or suit, decoration by multiple branches of the military, and a record of exemplary service in response to some of the great crisis events of recent years."  Those interested in the history of RxP would appreciate that Morgan Sammons and John Sexton were the first two DoD prescribing psychologists.  The RxP agenda is all about, and always has been primarily about, serving society and making psychological services more readily available for those who would clinically benefit from our expertise.  It has further been our observation over the years, as California Psychological Association practice leader Chuck Faltz has emphasized on numerous occasions, when CPA was active in pursuing RxP, the membership became meaningfully engaged and significantly increased their participation, both in numbers and financial contributions.  When CPA hit a hiatus, membership involvement slowed down dramatically.  At the Uniformed Services University of the Health Sciences (USUHS) (DoD), psychology and nursing are increasingly collaborating on developing integrated and interdisciplinary training modules.  Mark Skrade, President of the School of Professional Psychology at Forest Institute, continues to move forward on his vision for a joint PsyD-Advanced Practice Nursing or Physician Assistant dual degree program, with an emphasis on primary care.  Graduates of these programs will undoubtedly possess a rich appreciation for the nuances of ACA's integrated care.

New Horizons For Those With Vision:  A high personal priority of the NIH Director, the National Center for Advancing Translational Sciences (NCATS) was established at the National Institutes of Health (NIH) on December 23, 2011, with the mission to catalyze innovations aimed at enhancing the development, testing, and implementation of diagnostics and therapeutics across a wide range of human diseases and conditions.  By improving the process of translation, NCATS enables scientists in both the public and private sectors to develop drugs, devices, and diagnostics more efficiently for any number of diseases, ultimately accelerating the pace at which they are delivered to the patients who need them.  The NCATS budget document ($665.7 million) notes that there have been dramatic advances in our understanding of the molecular pathogenesis of disease in recent years, and by pairing this knowledge with advances in technology and with expert partners, NCATS is on its way to transforming the translational research process into an efficient and collaborative enterprise.  By focusing upon commonalities across diseases and organ systems, NCATS complements the work of other NIH institutes and centers as well as that of its pharmaceutical, foundation, and advocacy partners.

To date, NCATS has become a hub of innovation for translational sciences.  The Center has launched several major research initiatives, cultivated promising strategic partnerships, and established a presence at the NIH and in the community.  The milestones include: guiding an evolution of the national network of clinical and translational research institutions; overseeing an innovative grant program to create new tools for predicting drug toxicity in partnership with the Defense Advanced Research Project Agency (DARPA) and the Food and Drug Administration (FDA); and developing a breakthrough partnership program with eight pharmaceutical companies to find new uses for existing drugs.

NCATS supports the development, demonstration, and dissemination of a broad range of technologies, tools, and resources that facilitate collaborative pre-clinical testing and first-in-human clinical trial implementation.  Through its Clinical and Translational Science Awards, NCATS supports institutions across the country in their efforts to improve the quality, validity, generalizability, and efficiency of clinical and translational research.  The Research Electronic Data Capture (REDCap) system, a freely available powerful enterprise electronic data capture tool that is easy for investigators to use, provides capability for conducting clinical research studies quickly and securely.  Integrated clinical data repositories at supported institutions and policy agreements that allow searches across multiple institutional repositories facilitate clinical trial recruitment and hypothesis generation.  These tools are helping amalgamate supported institutions into a national network for observational and interventional trials.

In order for NCATS to meet its mission, the biomedical [and we would add behavioral] workforce must be sufficient in size and equipped with the requisite knowledge and skills for advancing the relatively new discipline of translational science.  NCATS supports a dedicated clinical and translational research training pipeline to ensure that our nation has the trained research team members needed to move basic research finding into the clinic.  Over 4,100 researchers have been trained so far.  These supported training programs incorporate nationally endorsed core competencies required for translational researchers, including the principles and application of translational science, collaborative team science, project management, and entrepreneurship.  Training competencies focused on therapeutic development are currently being developed.  NCATS is committed to increasing its support for accelerating the bench-to-bedside process.  In the coming year, NCATS proposes to greatly expand its successful drug repurposing initiative to encompass up to 100 rare diseases which currently have no treatment.  NCATS's highest priority is to advance the discipline of translational research by catalyzing the development of innovative methods and technologies that accelerate the development, testing, and implementation of diagnostics and therapeutics across a wide range of human diseases and conditions.  We fully expect that future budget documents will highlight NCATS's yet to be discovered interest in the mental and behavioral health fields.

            Retirement Perhaps, For Some:  "I appreciate your emails focusing on the major changes in health and different retirement patterns.  In my case they go together.  I work about half time as a contract psychologist with the Coast Guard Training Base-Petaluma Medical Clinic.  The base is an hour and a half north of San Francisco in the wine country and about a half hour from Bodega Bay on the Pacific where my wife and I live.  It's a great combination of environments.  I have completed my third year at the Coast Guard Clinic collaborating with a Coast Guard Physician(s) and Physician Assistant along with a dozen Health Service Assistants and additional Health Professionals.  I determined on starting here to find every psychology way to be helpful to these Coast Guard members and our Coast Guard patients.  So I have been able to make use of my broad background seeing patients/clients in universities, country hospital, USAF bases, public health, public agencies, a private in-patient clinic, as well as professional school contexts.  As I have worked here in consultation, short and long term psychotherapy roles, as well as in emergency triage situations, I thought how indebted I am to the psychologists from whom I have learned directly and indirectly, those researchers/theorists, and of course practitioners.  Then it popped into my mind: 'I belong to a noble profession,' experiencing being proud of being in our profession.  We would do well to describe our profession in this way to students and young psychologists.  We can get too lost in our disagreements and conflicts.  My best, [Rod Nurse]."  According to the National Park Service, Dinosaurs were a remarkably successful group of animals.  They lived on the Earth for 160 million years.  Their world and that of psychology has radically changed.  Aloha,

 

Pat DeLeon, former APA President – Nebraska Psychological Association – September, 2013

AN EVOLVING PERSPECTIVE

 During my years of service on the U.S. Senate staff, it was interesting to reflect upon how those committed to public service were truly fortunate to be able to focus upon developing programs that are effective, rather than exclusively being responsible for individual clinical outcomes, regardless of how personally satisfying that might be.  Increasingly, this broader perspective is now occurring within the private sector, particularly with the emphasis upon wellness, prevention, and integrated care fostered by the Patient Protection and Affordable Care Act (ACA) of the Obama Administration.  The hallmark of psychology's legislative success used to be whether there was an express mention of the term "psychology" in the underlying federal or state statutes; for example, authorizing the expertise of psychologists within the federal criminal code when issues of mental competence were being deliberated by the federal courts (accomplished at the request of the Reagan Administration, thanks to Bruce Bennett and former Hawaii Psychological Association President Barbara Porteus).  Today, there is an increasing emphasis upon whether the functions performed by psychologists are expressly recognized.  By definition, this approach reflects the policy recognition that the various behavioral health professions do significantly overlap in their expertise and raises the intriguing question of what is unique about their underlying training orientation that could/should be shared.  At the DoD Uniformed Services University of the Health Sciences (USUHS), I have been very impressed by the extent to which psychology and nursing, in particular, have been developing integrated and interdisciplinary oriented training opportunities.

            DoD Congressional Vision:  During this year's deliberations on its Fiscal Year 2014 recommendations for the Department of Defense, the House Appropriations Committee highlighted several issues of particular interest to public service psychology, especially when one appreciates that the underlying policy recommendations have relevance beyond that of any particular service (e.g., are relevant to those colleagues working within the federal bureau of prisons).  Under the Defense Health Program account (recommending $33.5 billion): "Mental Health Access For Servicemembers -- The Committee remains concerned with the ongoing stigma associated with servicemembers seeking assistance for mental and behavioral health issues.  The Committee encourages the Assistant Secretary of Defense (Health Affairs) and the Service Surgeons General to leverage all existing resources, within both military and civilian facilities, to provide comprehensive mental and behavioral health services to servicemembers and to continue efforts to reduce this stigma."

            The House Committee also expressed its support for the notion of Embedded Mental Health Providers, which was a visionary concept championed by Morgan Sammons when he was psychology specialty leader for the U.S. Navy.  "The Committee understands the tremendous toll exacted on all servicemembers and their families, including those in the special operations and National Guard and reserve communities, after more than a decade of war.  The Committee has always made the care of forces and their families its highest priority.  The Committee appreciates the focus that the Commander, Special Operations Command, has put on the psychological health and well-being of special operations forces and their families and recognizes the importance of providing support to this vulnerable population.  Further, the Committee recognizes the success of the embedded behavioral health program and fully supports its expansion to the special operations community.  However, the Committee believes that the mental health needs of all servicemembers, including special operators, are most appropriately addressed within the Defense Health Program by the Service Surgeons General to ensure the highest quality continuity of care for the servicemember.  Therefore, the Committee recommendation transfers $21,300,000 requested within the Special Operations Command operation and maintenance budget to the Defense Health Program to address the needs of the special operations community.  The Committee directs the Service Surgeons General to work with the Commander, Special Operations Command, to implement an embedded behavioral health program for special operations units during fiscal year 2014. 

            "The Committee also recognizes that National Guard and reserve personnel in states at high risk for suicide and dangerous behavioral health conditions need convenient access to mental health professionals for proper screening and care.  Onsite access to embedded mental health specialists during training assemblies has proven successful in overcoming geographical, stigma, and time barriers that might otherwise bar a member from similar services in an underserved community.  The Committee encourages the Secretary of Defense to work with the Chief, National Guard Bureau and Service Surgeons General to implement an embedded behavioral health program for National Guard and reserve component servicemembers in order to provide reserve component personnel with ready access to screening and treatment during unit training assemblies and urges the Secretary of Defense to robustly fund these programs."

            USUHS's Appreciation of the Future:  At USUHS, the Graduate School of Nursing doctoral program recently held its Wellness Boot Camp.  "We are all familiar with the scientific foundations of stress and the negative long-term effects of chronic stress -- whether the focus is research, clinical practice or health policy and program development.  The rigors of doctoral studies and professional life frequently result in marathon chair time, compressed sleep schedules and little time to exercise and plan healthy nutritional options.  These physical and psychological challenges can easily result in poor health habits that carry on well into professional careers.  A common complaint is that there is no time for self-care.  Ironically, the health goals of the collective international community are expressed in the World Health Organization's (WHO) goal, 'to improve equity in health, reduce health risks, promote healthy lifestyles and settings, and respond to the underlying determinants of health.'  The goals and objectives of the AMA, APA, APhA and ANA all share adaptations of this overarching goal.  Logically the easiest solution to improved health is through identifying risk factors, building protective factors and targeting preventive measures; however, the complexity of life outside of the research lab is replete with human emotions, behaviors, genetics and environmental factors.

            "The USUHS Graduate School of Nursing Ph.D. program recognizes the health risks associated with doctoral studies, values the health of its students and faculty, and practices prevention.  Because people are the most important investment, mitigation and prevention of stress-related conditions were the focus of our recent GSN Wellness Boot Camp.  Integrative health care and evidence-based modalities for self-care were addressed during the half-day camp.  The venue included didactic and experiential learning in the art and science of mindfulness meditation, progressive muscle relaxation, guided imagery, yoga, Reiki and laughter yoga.  Significant research relevant to military populations such as imagery rehearsal for post-traumatic nightmares, mindfulness-based stress reduction for healthcare workers and the use of complementary and alternative medicine in VA specialized PTSD treatment programs were highlighted.

            "Students and faculty attendees were able to network with the Senior Program Manager for Military Research, and the Optimal Healing Environment Program Manager of the Samueli Institute.  The latter provided a review of the physiology of stress and reminded the group that the simple act of three full breaths can change the physiology of both our breathing and our mind.  We were led through guided imagery exercises and provided research outcomes on the benefits of guided imagery for pain management in surgical patients, as well as in individuals with phantom limb pain.  The Walter Reed National Medical Center's therapeutic yoga instructor demonstrated supportive yoga poses that promote calm, concentration and relaxation, and are frequently used in the rehabilitation of Wounded Warriors.  Reiki master Jennifer Rawlings won over the crowd with a brief demonstration of Reiki on our doctoral chair, Dr. Penny Pierce.  The camp concluded with roars of laughter as my fellow USAF student Jackie Killian, a certified laughter yogi specialist, provided a preview of her doctoral research in the area of the physiological effects of laughter yoga complete with group exercises of purposeful and spontaneous laughter.

            "The take away from Boot Camp is a challenge for all of us.  As we continue to conduct research, incorporate finding into practice and design programs to reduce stress, prevent illness and promote resilience, we would each benefit from practicing these evidence-based mind-body modalities in our busy lives.  Perhaps the effects would not only be enjoyed by us but by our colleagues, families and patients.  It was particularly supportive to see Dr. Chip Rice, USUHS President, present that morning.  Our healthcare vision is evolving (Laurie Migliore, USAF)."

            The National Institutes of Health:  The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on various complementary health interventions and their potential role in integrative strategies for treating difficult health conditions and promoting better health.  NCCAM is committed to building the scientific evidence needed by consumers, providers, and health policymakers regarding the safety and usefulness of these approaches to improve health and health care.  The President's Fiscal Year 2014 budget request for NCCAM is $129 million, a slight increase over the previous year.  According to its budget justification, nearly 40% of Americans are integrating complementary health interventions into their health care and personal health practices, at an annual cost of $34 billion.  While decisions about the use of these interventions are sometimes made with the guidance of a professional health care provider, this is often not the case.  Furthermore, both consumers and providers are often confronted with limited objective information about the safety and effectiveness of these approaches.  To address these evidence gaps, NCCAM funds research across the continuum of basic, translational, and clinical research, guided by its strategic plan.

            A major focus for NCCAM is research related to chronic pain, an enormous public health problem that affects 100 million Americans and costs at least $635 billion per year in treatments and lost productivity, according to the Institute of Medicine (IOM).  Current drug-based treatment options are only partially effective and can have serious side effects.  Research exploring non-pharmacological approaches for treating chronic pain is a top Center priority.  In the past year, one supported study provided strong evidence that acupuncture may be helpful for chronic pain and another study suggested that spinal manipulation or exercise is more effective than medication for acute neck pain.  NCCAM will continue to support rigorous basic, translational, and clinical research to understand whether such interventions add value to existing approaches and to identify the biological mechanisms by which they exert beneficial effects.  A recent effort focuses on the use of complementary approaches to pain and symptom management in military and veteran populations.  This effort encourages collaboration between NCCAM-funded researchers, other NIH institutes and centers, and researchers at DoD and VA.

            NCCAM's intramural research program focuses on understanding the central mechanisms of pain and its modulation, with the long term goal of improving clinical management of chronic pain through the integration of pharmacological and non-pharmacological approaches.  Of particular interest are the mechanisms by which emotion, attention, placebo effects, and other such processes modulate pain or pain processing.  The program will be highly collaborative within the larger NIH neuroscience research enterprise.

            Research on the safety of natural products is another major priority, given the widespread availability and use of these products by the public.  One area of particular need is better scientific information about interactions between natural products and drugs.  The Center also remains committed to strengthening "real world" outcomes and effectiveness research that capitalizes on the reality that many complementary and integrative approaches are in widespread public use.  As such, NCCAM leads the development of the complementary health questions, which are included every five years in the National Health Information Survey conducted by CDC and the National Ambulatory Medical Care Survey involving interviews with 30,000 physicians.  Data from these two surveys is expected to provide the most current and comprehensive picture of the use of complementary and integrative health practices in the nation.   Finally, to help the public and practitioners make informed decisions about the use of complementary and integrative health interventions NCCAM disseminates its research findings, providing reliable, objective, and evidence-based information through multiple channels.  Aloha,

Pat DeLeon, former APA President – Division18 – September, 2013

PLEASANT MEMORIES – MEANINGFUL CONTRIBUTIONS

 The 121^st APA annual convention was a tremendous success with approximately 11,400 registrants.  HPA President Darryl Salvador's Opening Session Aloha and the accompanying Native Hawaiian dancing and music were extremely well received, especially by our colleagues from the Mainland.  Hawaii has much to be proud of.  The Hawaii Prepaid Health Care Act, enacted back in 1974, was one of the models for President Obama's landmark Patient Protection and Affordable Care Act (ACA) and accordingly, is expressly "grandfathered," as long as its benefits meet the evolving national standards.  A decade later in November, 1984, U.S. Senator Daniel K. Inouye urged the HPA to obtain prescriptive authority in order to better serve their clients, resulting in psychology's first RxP legislative efforts in the nation.  The Hawaii Health Connector (Health Insurance Exchange), under the leadership of Coral Andrews, has been focusing upon diversity at all levels of the health care industry, as it prepares to "go live"on October 1^st.  The implementation of the state based marketplace will complement the existing ecosystem but also contribute directly and indirectly to the development of new business models, new professional structures, and new models of care -- again, in the forefront of the nation.  As non-physician providers finally come into their own, a wide range of disciplines will emerge in leadership positions to support the requirements necessary to fully implement ACA.  New markets and new approaches will emerge, notwithstanding the considerable pain inherent in substantive change.

Since retiring from the late Senator's staff, I have been pleased to be affiliated with the William S. Richardson School of Law at the University of Hawaii.  Under the leadership of Dean Avi Soifer, the School has established new programs in Native Hawaiian Law and Health Policy.  Dina Shek administers a most progressive interdisciplinary Medical-Legal Partnership for Children (i.e., legal services clinic) at the federally qualified Kokua Kalihi Valley (KKV) Community Health Center and positive discussions are evolving with the West Oahu Vet Center.  Those who are served by these sites have very unique and pressing psychosocial-legal needs as Don Bersoff's APA Presidential programming identified.  On a personal note, over the years I have been most impressed by the successful and truly holistic community outreach efforts at KKV.  For example, their spacious culturally sensitive food garden targets the life journey of their Polynesian and Pacific Basin clientele, as envisioned by Executive Director David Derauf.  "Healing can and needs to take place at so many levels; sometimes the healers heal and sometimes they are healed.  Sometimes, when we come together as a community, whether we are doctors, lawyers, psychologists, grandparents, or grandchildren, we find that we can figure these things out together, heal each other and our community."  What a wonderful opportunity for meaningful engagement by students in law, psychology, and nursing.

At our APA gathering, Illinois's Beth Rom-Rymer was able to convey the enthusiasm steadily generating within the RxP movement across the nation and internationally.  "In Ontario, requests for extending scopes of practice to include prescriptive authority are directed to the Minister of Health.  The RxP Committee submitted our request in November, 2012.  We have been advised that a ruling on RxP is 'on hold,' pending other requests for legislative change, as the Minister would prefer 'opening up' legislation for more than a single change.  We have a number of meetings scheduled with various officials to discuss how prescribing psychologists would benefit a number of Ministry initiatives in an effort to move the process along.  It should be noted that the provincial government supports non-physician prescribing and has already granted prescriptive authority to other healthcare professionals, such as nurse practitioners, optometrists, naturopaths, pharmacists, and midwives (Jane Storrie and Diana Velikonja, co-chairs)."

            The Congressional Vision:  During its deliberations on the FY 2014 budget for the Department of Health and Human Services (HHS), the Senate Appropriations Committee highlighted several items of particular interest to psychology.  The level of funding for the Native Hawaiian Health Care Program, which in 2011 served more than 8,400 people, is to remain level at $14.4 million, notwithstanding overall budget reductions.  HRSA and SAMHSA are encouraged to continue collaborating in order to develop and replicate community health worker programs that integrate primary care and behavioral health, and provide a report on their efforts for next year's budget.  Under the Graduate Psychology Education initiative, thanks to the efforts of APA's Cynthia Belar, support was expressed for the Secretary's initiative to increase the number of psychologists pursuing clinical work with high-need and high-demand populations.  These are defined as rural, vulnerable, and/or underserved populations, as well as veterans, military personnel, and their families.  "While the Committee commends the emphasis on programs targeting veteran and military personnel population centers, the Committee is concerned that many service members reintegrate into civilian life in communities that are rural and far from military and veteran facilities.  As such, the Committee encourages HRSA to maintain a strong commitment to underserved areas generally."  Those interested in the legal and RxP agendas should note that: "According to a December 2012 GAO report, an alarming 18 percent of foster children are prescribed psychotropic medications, compared with 4.8 percent of privately insured children.  The Committee strongly encourages SAMHSA to establish meaningful partnerships with Medicaid, the foster care program, medical specialty societies, and treatment centers to develop new strategies for treating this vulnerable population.  The Committee would like an update in next year's congressional [budget] justification on the steps SAMHSA has taken to promote the most effective and appropriate treatment approaches, including the use of evidence-based psychosocial therapies instead of, or in combination with, psychotropic medications."

Health psychologists and those who contemplate the long term benefits of integrated care should be pleased with the Committee's recognition of the National Institute on Aging for its investment in large-scale longitudinal surveys, including the National Health and Aging Trends Study and the Health and Retirement Study.  The Senate Committee particularly applauded the National Academies of Science report "Shorter Lives, Poorer Health," which found that Americans live shorter lives and are in poorer health than people in other high-income countries and that behaviors and social circumstances are major contributing factors.  And, as Coral indicated earlier, nurses, in particular, are making significant strides in establishing leadership opportunities as reflected by the Senate's directive that "no less than" $5 million shall be awarded during the coming year to nurse-managed health centers, one of the visionary components of ACA.

            The Past Will Return, Eventually:  During the 110^th Congress Senator Edward Kennedy, Chair of the Health, Education, Labor and Pensions (HELP) Committee favorably reported out of his Committee on October 1, 2007, S.1693, the Wired for Health Care Quality Act, which was a precursor for today's Health Information Technology (HIT) era.  At the time there were 11 cosponsors of the bill, eight of whom were Republicans.  Senator Hillary Rodman Clinton was one of the Democratic cosponsors.  The days of bipartisanship in furtherance of the nation's business will eventually return.  In the meantime, Hilo's Judy Steinman reports: "Our first graduate to take the PEP passed on his first try and he just received his credentials to prescribe.  Another one of our first cohort is enlisted in the USAF and moving to Arizona.  There is a medical psychologist there so she hopefully will be able to complete the program from there.  We are graduating all four of our second cohort students this summer.  Two are planning to take the PEP and two (civilians) are not planning to take it now because they are going to work in states that do not yet have RxP.  One will work in an oncology department so I feel that we are spreading our training into useful areas."  Aloha,

 

Pat DeLeon, former APA President – Hawaii Psychological Association – September, 2013

EXCITING TIMES – CHANGE IS DEFINITELY IN THE AIR

 Throughout the 121^st APA annual convention, held this year in beautiful Honolulu, there was a palpable sense of excitement in creating and responding to unprecedented societal change.  Cynthia Belar described APA's efforts to advance quality in the education and training of health service providers consistent with the realities of the nation's evolving health care environment, especially with the emphasis of President Obama's Patient Protection and Affordable Care Act (ACA) on interdisciplinary, holistic, and integrated systems of comprehensive care.  These efforts include both the articulation of required competencies and the affirmation of accreditation of doctoral and internship programs.  Steve DeMers, Executive Director of the Association of State and Provincial Psychology Licensing Boards, described their efforts, in conjunction with APA and impressively with federal HRSA support, to foster licensure portability for the forthcoming era of telehealth practices.  We wonder if future licensure standards will require enrollment in doctoral programs and in clinical internships that are nationally accredited?  Many are already arguing for a "single standard."  It is becoming clear that this far reaching policy determination may well evolve as the nation steadily advances towards what must be considered national licensure (i.e., uniform standards of practice) for each of the health care professions.

APA President Don Bersoff hosted a most impressive Military-Veterans programmatic theme, addressing a wide range of timely topics including resiliency, family dynamics, evidence-based approaches to the signature wounds of a decade of conflict, and the honor of serving our nation.  Debra Dunivin and Morgan Sammons participated in a moving tribute to Medal of Honor winner, the late U.S. Senator Daniel K. Inouye.  The importance of proactively responding to change was clearly highlighted from a number of perspectives.  For example, serious consideration is finally being given to former APA President Bob Resnick's charge to integrate psychopharmacology training at the pre-doctoral level – perhaps through  joint degree initiatives such as contemplated by the Chicago School of Professional Psychology and others in Illinois; capitalizing upon the unique RxP expertise at Colleges of Pharmacy (University of Hawaii at Hilo); and, creative initiatives such as Forest Institute contemplating the development of a joint PsyD-PA and/or PsyD-APN degree with a focus on primary and integrated care.

Advances in Psychopharmacology (RxP):  Beth Rom-Rymer coordinated a number of perspectives on the maturing RxP agenda, including in her home State of Illinois.  "We have had a remarkable 14 months.  On March 6^th, 2012, the Illinois State Senate Public Health Committee passed our RxP bill out of Committee by a vote of 6-4.  With our lobbyists, we made the critical decision to spend the next 12 months educating our psychologists and legislators around the state on RxP issues; training Illinois psychologists in becoming effective advocates for RxP; and reaching out to mental health associations, social service organizations, law enforcement agencies, hospitals, mental health centers, physician groups, etc. to educate about, and advocate for, RxP.  Because of the strength and longevity of our lobbyists' relationships with our legislators and because of our Illinois psychologists' impressive advocacy and outreach efforts, we have been very fortunate to work with strongly committed and dedicated legislative chief sponsors: Senate President ProTem Don Harmon, Senator Dave Syverson, Representative John Bradley, and Representative Jim Sacia.  On March 12^th, 2013, our RxP legislation passed out of the Senate Public Health Committee by the unanimous vote of 8-0 with one abstention.  On April 25^th, 2013, our RxP legislation overwhelmingly passed out of the Senate by a vote of 37-10 with 4 abstentions.  On May 7^th, 2013, our Senate bill was placed in the House Executive Committee.  Over the next several days, we were continually conferring with our lobbyists over the advisability of calling our bill.  As I said, we made the strategic decision that we wanted to take more time to work with our Representatives so that the vote would reflect an informed understanding of the issues.  We will be working very closely over the next several months with our legislators and all of our third party groups around the state.  We are very fortunate that although this legislative session has concluded on May 31^st, we are in the first year of a two year sequence.  We are, therefore, able to build on all of our terrific accomplishments to date and focus on the House.  We are also in productive discussions with the Governor's Office.  We are looking toward achieving passage during our next legislative session in the spring of 2014.  Together, we are forging a path in Illinois to make a significant change in the way healthcare is being delivered.  There is no turning back."

Bob McGrath and NJPA President Sean Evers reported on their RxP efforts.  The New Jersey bill passed out of the Assembly Regulated Professions Committee on December 6^th, 2012.  It then passed out of the Assembly on April 29^th, 2013 with a vote of 41 to 27, with 8 abstentions and 4 not voting.  The bill remains active.  "We've learned a number of important lessons along the way, including the identification of a core group that maintains control of the bill and its advocacy, the importance of a lead lobbyist with strong expertise in passing legislation, and the key issues to address at different points in the legislative process.  It's been a long, long ride, from the first discussions of prescriptive authority in New Jersey in the early 1990s till now, but we remain optimistic about our chances for the near future."  In California, home of the original Doctor of Mental Health effort in the early 1970s, former CPA President Sallie Hildebrandt reported that they are once again embarking on a long-term, comprehensive grass-roots statewide effort to pass RxP legislation.  They have begun a major fundraising effort led by Sallie, Chair of Division 5 (Clinical Psychopharmacology).  During the convention, involved colleagues including Elaine LeVine, the first civilian female prescribing psychologist, and Steve Tulkin discussed maturing RxP interest internationally, including in New Zealand, Canada, and Africa.

It is important to appreciate that the "power" (i.e., authority) to prescribe is also the power (i.e., legal standing) to unprescribe or appropriately modify what has been prescribed.  The critical underlying objective has always been to provide the highest quality of psychological care to our patients.  In this light, it is of interest that the Senate Appropriations Committee noted in its FY 2014 report: "Psychotropic Medications and Children. – The Committee has become increasingly concerned about the safe, appropriate, and effective use of psychotropic medications and children, particularly children in foster care settings.  According to a December 2012 GAO report, an alarming 18 percent of foster children are prescribed psychotropic medications, compared with 4.8 percent of privately insured children.  The Committee strongly urges SAMHSA to establish meaningful partnerships with Medicaid, the foster care program, medical specialty societies, and treatment centers to develop new strategies for treating this vulnerable population.  The Committee would like an update in next year's congressional [budget] justification on the steps SAMHSA has taken to promote the most effective and appropriate treatment approaches, including the use of evidence-based psychosocial therapies instead of, or in combination with, psychotropic medications."  Under the Office of the Secretary the Committee included additional language: "Prescriber Education. – The administration's 'Prescription Drug Abuse Plan' called on the Department to work with the Department of Justice and the Office of National Drug Control Policy on ways to educate practitioners on safe and proper prescribing of opioid painkillers as a prequalification for those individuals obtaining a Drug Enforcement Administration license to prescribe and dispense controlled substances.  The Committee requests an update on these efforts in next year's congressional [budget] justification."

            The Department of Veterans Affairs:  The VA serves approximately 49.3 million beneficiaries, constituting 15.5 percent of the nation.  It operates the largest Federal health care delivery system in the country, with 152 hospitals, 107 domiciliary residential rehabilitation treatment programs, 133 nursing homes, 300 Vet Centers, and 821 outpatient clinics.  It is estimated that 6.5 million patients will be treated in the coming year.  The VA is the largest employer of psychologists and Advanced Practice Nurses (APNs).  It is in the forefront of providing post-doctoral training opportunities under the leadership of Robert Zeiss (whose wife Antonette Zeiss received the APA Outstanding Lifetime Contributions to Psychology Award at the Opening Session).  Within the VA, our nursing colleagues have done a remarkable job of advancing their scope of practice in order to provide quality care to their patients.  Under the leadership of Cathy Rick, Chief Nursing Services Officer, the new VHA Nursing Handbook, will provide APNs with the authority for independent practice, regardless of individual state licensure limitations, unless an individual VA facility limits their scope within that facility.  This visionary document has been "cleared" by the relevant legal authorities who will be reminding hesitant states about the federal government's supremacy powers within federal facilities.  The handbook notes that research and evidence-based practice have demonstrated the significant and synergistic relationships between delivery of nursing care, patient and resident outcomes, and staff satisfaction, as well as process effectiveness and efficiency.  It recognizes that nursing care is complex and that paradigms have and will continue to shift.  The basic tenets of VHA nursing are to be aligned with the ANA Standards of Practice and achieved through evidence-based practice, defined elements of practice, and professional development.  Two key components are that the patient owns and drives their care based on the information available and that nursing interventions are based on the best available evidence and accepted standards of practice.

Specifically:  "Clinical nursing practice varies widely among the States.  To ensure safe and appropriate health care to the nation's Veterans, VA has standardized the elements of practice, within VA, for clinical nursing practice other than the prescribing of controlled substances, without regard to individual State Practice Acts.  This ensures a consistent standard of nursing care throughout VA's national health care system….  Under the Federal Controlled Substances Act… a health care practitioner may prescribe controlled substances only if the practitioner's State license authorizes such prescribing.  Accordingly, APRNs, including NPs, may prescribe controlled substances within VA only if they are authorized to do so by their State of licensure or registration and comply with the limitations and restrictions on that prescribing authority.  Where VA establishes elements of nursing practice that are more expansive or otherwise inconsistent with State practice standards, VA's practice standards control.  VA nurses must follow the VA nursing practice standards established in VA rules, regulations, and policies."  This is a mostimpressive development for our nursing colleagues which we understand will soon be published in the Federal Register for public comment.  The readership should recall that the American Association of Colleges of Nursing (AACN) announced that in October, 2004 their member schools voted to endorse moving the current level of preparation necessary for APNs from the master's degree to the doctorate-level (i.e., the Doctor of Nursing Practice (DNP)) by the year 2015.  Psychology can learn a lot from our nursing colleagues.

            In its deliberations for FY 2014, the House Appropriations Committee urged the VA to strengthen collaborations with research universities and teaching hospitals for the treatment and research of mental health disorders, such as PTSD and traumatic brain injury, to improve the psychological health of veterans and train mental health professionals so they will understand the unique needs of veterans.  The Committee further noted that: "Previous wars have shown that the health care needs of a returning service member population reach their highest point a few decades after the population returns home from war.  The Committee is concerned that the VHA is not adequately preparing for the future mental health needs of the current veteran population.  The Committee requests that VHA prepare a report on what health resources will be needed and the potential cost to serve the needs of Iraq and Afghanistan veterans over the next 30 years."

We believe that competition per se is best for all concerned, especially within the health care arena.  The recently adopted APA policy on accreditation described by Cynthia provides an opportunity for other accrediting groups to evolve, if recognized by the U.S. Secretary of Education.  Accordingly, the House Appropriations Committee's recommendations regarding the psychology accreditation process is most timely.  "The Committee is aware that the Psychological Clinical Science Accreditation System (PCSAS) in September 2012 received recognition and accreditation authority from the Council for Higher Education Accreditation to provide accreditation of PhD programs in psychological clinical science.  The Committee understands that the VHA is in the process of modifying its regulations to permit the training and employment of psychologists at the VHA who are graduates of PCSAS-accredited programs, and urges the VHA to promulgate the regulatory changes as soon as possible in order to increase the number of mental health clinicians available to veterans using the VA healthcare system."  We would expect that similar flexibility will soon evolve during state licensure deliberations.

Change is Definitely Coming:  During this year's deliberations, the Senate also expressed its considerable enthusiasm for the underlying holistic approach of the ACA.  "Integrative Medicine. – The Committee is aware of controlled clinical trials that have shown promising results for mind-body approaches to preventing and treating hypertension, other cardiovascular risk factors, and cardiovascular disease.  Additional research is warranted to determine if integrative medicine interventions offer a unique opportunity to improve the quality of care while reducing healthcare costs from the Nation's leading causes of death.  The Committee encourages CMS to test integrative health interventions to determine health outcomes and the potential for healthcare savings.  In particular, the Committee is supportive of research into mind-body interventions for cardiovascular disease that have been previously shown in peer-reviewed publications of clinical trials to reduce cardiovascular risk factors, mortality, myocardial infarction, and stroke."  In many ways, mental health is nicely maturing itshealth care presence.  A 1944 painting, commissioned as part of the Works Projects Administration (WPA) artists' program of World War II, illustrated the historical function of the Forest Glen annex of the Walter Reed Army Medical Center as a holding and rehabilitation unit for medical patients.  At that time, psychiatric patients were identified, and to an extent stigmatized, by wearing maroon hospital clothing.

An Island Perspective:  "Nice to visit with you.  We finally managed to be on the Island of Hawaii at the same time!  Sorry the weather didn't cooperate for a canoe paddle on the bay.  But the possibility brought out some interesting thoughts about your approach to retirement and mine.  I think the common ground is that we are both loving the opportunity to experience retirement by doing things that we choose to do, rather than things dictated by our jobs and professional roles.  And, even if some (or many) of those things are like those of our former jobs, the ability to choose how we spend our time is what defines 'retirement.'  So, in your case the opportunity to have a bigger role in academic life and experience the joys and challenges of teaching is a satisfying and rewarding experience.  For me, after 35 years in academia I am enjoying other challenges.  In spite of the fact that I was very happy and fully engaged in the academic world throughout my career, toward the end I began to look forward to the time when I would not have to give another lecture or grade another exam.  Instead, I now enjoy waking up and getting to choose whether I will go surfing, paddling, sailing or even snowboarding and skiing on Mauna Kea.  And, weather permitting, it is nice to be able to take my friends along!  My first project upon retirement was to build a 400 square foot workshop in my backyard so I could fix and make 'stuff.'  The pleasure of making something tangible after living in the world of intangibles that is so much of academic life has been very satisfying.  So, Pat, I guess from my perspective the most important aspect of retirement is that it gives us the opportunity to decide how we spend our time.  The important thing is the choice of activities that are satisfying, not the details of what those activities are.  'Smile' back at ya! [Jerry Johnson, retired Professor, University of Hawaii at Hilo]."  Aloha,

Pat DeLeon, former APA President – Division 42 – August, 2013