ALOHA - D29 column

“THIS COUNTRY WILL NOT BE A PERMANENTLY GOOD PLACE FOR ANY OF US…”

            Developing a Visionary Perspective:  After nearly four decades of involvement at the federal policy level, we have come to appreciate how those who serve in higher office (whether within the Congress, the Administration, or their national professional associations) often develop an intuitive understanding of the “waves of change” and how their interests and expertise must continue to evolve in order to remain relevant and “cutting edge.”  Former APA Presidents Suzanne Bennett Johnson and Susan McDaniel emphasized the importance of psychology affirmatively embracing interprofessional integrated care.  Psychologist Peter Kaufmann, former Acting Director of the Office of Behavioral and Social Sciences Research at the National Institutes of Health and former President of the Society of Behavioral Medicine, recently transitioned to the University of Colorado’s College of Nursing as Associate Dean of Research.  He finds that nursing faces challenges similar to those of psychology with respect to research and practice, yet both can learn from one another.  Colleagues invested in mental and/or behavioral health must appreciate the fundamental importance of regularly interacting with the other disciplines (e.g., nursing, clinical pharmacy, social work, physician assistants, and medicine) which are essentially working with the same patients or systems/organizations; notwithstanding our different professional training backgrounds.  Fundamental change evolves from collective past experiences and challenges.

            Two of Susan’s 2016 Presidential Initiatives exemplify this commitment to increasing psychology’s role in interprofessional integrated care.  “The first initiative took a year to accomplish: developing a meeting of Presidents and CEOs or Government Relations people of all the primary care and mental health professional associations (including family medicine, pediatrics, general internal medicine, psychology, psychiatry, social work, nurse practitioners, nurses, physician assistants, etc.).  We called it the Integrated Primary Care Alliance.  Eighty-three leaders from 28 associations met at the APA Tower Conference Center in April for two days, to work on inter-professional approaches to integrated primary care with regard to: advocacy, education, research methodologies, team-based care, and healthcare disparities.  Many of these leaders had never met each other, and few had been to APA.  More than a handful said this was the best meeting they had ever attended!

            “My second Interprofessional initiative was to develop a curriculum for an Interprofessional seminar for integrated primary care that will be taught early in the graduate training of all health professionals.  Psychology often does clinical training and research with other disciplines after receiving foundational education.  Other health professionals often have early seminars or classroom training together.  We typically get on the Interprofessional train a bit late.  Integrated primary care seems a perfect vehicle for such a seminar for psychology graduate students to learn with other health professionals about issues such as population health, healthcare financing, collaboration, the science of teamwork, etc. – topics that all disciplines need to learn and would usefully be learned together.

“To accomplish this task, we convened a group of talented expert educator psychologists who know integrated primary care and were already involved in Interprofessional teaching at the early graduate level.  This crackerjack group was co-chaired by Ron Rozensky and Jeff Goodie, with the able assistance of Catherine Grus from the Education Directorate.  We met once, but had many phone calls and emails before and after the meeting.  Once the curriculum was in solid draft form, we sent it to members of the Integrated Primary Care Alliance for feedback.  After incorporating their suggestions, the curriculum was posted to the APA web-site for anyone to access free of charge.  Check it out!  (http://www.apa.org/education/grad/curriculum-seminar.aspx).  I wish all psychology students (practice, science, applied) were required to have an Interprofessional seminar early in their career, before applying any of it in practice or on research teams.”  The era of perhaps comfortable, but unfortunately isolated professional silos is rapidly passing.  Those fortunate to work within visionary systems of health care delivery and/or educational institutions will find themselves increasingly exposed to exciting challenges and unprecedented opportunities.

Exciting Opportunities to Contribute:  Under the leadership of Dean Carol Romano, former Chief Nurse Officer for the U.S. Public Health Service, the Daniel K. Inouye Graduate School of Nursing (GSN) at the Uniformed Services University (USU) of the Department of Defense has recently initiated graduate student clinical placements in American Samoa.  Located in the South Pacific, midway between Hawaii and New Zealand, this site was chosen in 1872 as a coaling station for the U.S. Navy.  After the attack on Pearl Harbor on December 7, 1941, naval activity there increased significantly.  On January 11, 1942, a Japanese submarine surfaced off the coast of Tutuila and fired 15 shells from its deck gun at the Naval Station, most landing harmlessly in the bay.  This fire was not returned and it turned out to be the only Japanese attack on American Samoa during World War II.

American Samoa is a U.S. territory, covering seven islands and atolls.  Its current population approximates 55,500 with a land mass of 76.8 square miles, slightly more than Washington, DC.  It is noted for having the highest rate of military enlistment of any U.S. state or territory.  Today, health care is provided by the Department of Health (DOH), the Lyndon B. Johnson tropical medical center, a VA clinic, and a federally qualified community health center.  Traditional private practice is essentially non-existent.  With an extreme shortage of health professionals of all disciplines, as is all too common throughout rural America, health disparities are rampant.

            “Lt. Christopher Johnson (U.S. Navy) and I, Major Douglas Taylor (U.S. Army), were the first Graduate School of Nursing students from USU to complete a clinical rotation in American Samoa.  It was a three-and-a-half week rotation, the first of a new partnership between the USU and the Department of Health of American Samoa.  Professors Jill Schramm, Eric Pauli, and several other faculty members recognized the military and healthcare educational value of this experience.  They worked with American Samoan partners, Sandra King-Young, DOH Director Motusa Tuileama To’atolu Nua (retired US Army), and others to establish a Memorandum of Understanding (MOU) signed personally by the Governor of American Samoa and the President of USU.  Lt. Johnson is a Women’s Health and Family Nurse Practitioner student and I am a Psychiatric Mental Health Nurse Practitioner student.  Interestingly, Mrs. King-Young served as an American Samoan Fellow in the office of the late U.S. Senator Daniel K. Inouye.  In our judgment, this clinical experience was critical to our military mission, health education, and without a doubt, our personal growth.

           “The mission of a military health officer is ensuring a Ready Medical Force and a Medically Ready Force.  The medically ready force ensures our Service Members are ready for combat, but the ready medical force ensures that, as a health professional, I am ready to deploy and engage in medical care anywhere in the world.  Our clinical rotation to American Samoa expanded our ability to effectively meet the mission of a ready medical force.  The United States projects its presence in many ways and one such way is supporting, building, and contributing to the health stability of a region.  I have to be ready to engage local leaders, local media, and local health providers.  American Samoa provided a real-life testing of these skills.

“On our first day, jet lag in full force, we met with the Governor and Lt. Governor (a Veteran himself) and were surprised to find both news reporters and camera crew waiting to interview us (http://samoanews.com/visiting-medical-practitioners).  My training from Army Captains Career Course and media training from Operation Bushmaster (a field training exercise at USU) kicked in, and Lt. Johnson and I successfully navigated a media event, redirecting questions like ‘Will the U.S. military do anything about the supply shortages on the island?’ back to our clinical mission.  Lastly, each day on the island, we engaged with local health providers, providing education and mentorship – ensuring that our presence had a lasting change to island health care.

            “As a health professional, cultural competence is essential to providing relevant mental health treatment.  On this trip, I learned that major depressive disorder can present incredibly similar in American Samoa as it does in my practice at home.  I also learned about differences, such as how the American Samoan culture emphasizes the ‘We’ instead of ‘Me’ and that multiple members of the family will show up for an appointment.  I’m thinking specifically of Joan (not her real name) who was brought in by her two younger sisters for being ‘forgetful.’  When she was called into my office, her sisters came in with her.  At first, I assumed that it would be more culturally appropriate to include her family in the interview with her.  However, this assumption proved wrong and, in fact, Joan opened up much more when we were alone.  I learned that I had to be careful not to impose my beliefs of privacy, but also not to overcompensate by acting on misunderstood cultural norms.  I definitely still have much to learn in the practice of identifying cultural similarities and differences in the therapeutic relationship.  However, I know I am better at it for having served even so briefly in American Samoa.

            “Lastly, I grew as a person while in American Samoa and this can only be attributed to the people I met.  In particular, one person stands out as both an inspiration and hero.  Mrs. Mara Brown is the director at the Juvenile Detention Center.  I had the opportunity to meet her and the three counselors who work at her facility.  Prior to her arrival, the youth who passed through the detention center cells rarely completed high school.  Since she took over, 100% of the youth graduate from high school.  She turned the detention center from a focus on punishment to a focus on rehabilitation and recovery.  Two of her youth have gone on to join the military, one the postal service in Hawaii, and others have become productive members of the American Samoan community.  Often times, she and her counselors will work twelve-hour days or over the weekend without compensation.  It was amazing to see how one dedicated individual attained the right job, built the right team, and accessed the right resources to help the most vulnerable in our society.  I was able to share some of my knowledge with her and her staff during a two-hour education session on suicide assessment and prevention.  It was by far the most important work I did on the island and one of the most fulfilling moments of my professional life.  I am beyond thankful for the opportunity to practice in American Samoa.  I know I am better for it and I am confident that the people we met valued our presence.”  Hopefully, the psychology, public health, and other medical school specialties at USU will soon follow the leadership of the GSN.

            Substantive Change Takes Time:  In 1982, the Institute of Medicine called for: “(G)reater interdisciplinary collaboration within the scientific community and more communication between it and clinical practitioners….  Interdisciplinary collaboration is not an end in itself; rather, it is a means to a higher goal – solving a problem….  (I)t should be possible to construct a reasonably unified biobehavioral science pertinent to health and disease, with major applications in all the health professions and by the public at large.”  “(T)o live in unless we make it a reasonably good place for all of us to live in.”  Aloha,

Pat DeLeon, former APA President – Division 29 – October, 2017

 

IF YOU PLAY IT SAFE IN LIFE

A National Vision:  In December, 2013, following the service of Chairman Ron Rozensky, I was very fortunate to be appointed by Health and Human Services (HHS) Secretary Kathleen Sebelius to her Advisory Committee on Interdisciplinary, Community-Based Linkages (ACICBL), which provides policy and program development guidance for a number of the health professions training programs administered by the Health Resources and Services Administration (HRSA).  During his term as Chair of ACICBL, Ron noted that they co-signed a letter to Congress supporting the inclusion of funding for interprofessional healthcare in the Affordable Care Act (ACA) and their Annual Report to Congress stressed the importance of behavioral health integrated care.  "Having psychologists on this key federal advisory committee is an important mechanism that supports our voice being in the room when critical policy for tomorrow's interprofessional healthcare systems is being crafted."  This August, ACICBL issued its 15^th Annual Report to the Secretary and the U.S. Congress.  My term has now concluded; however, I am confident that rural America, our nation's Native Americans, and psychology will be well represented by Jacqueline Gray who will continue to serve on ACICBL.

            "The United States healthcare system strives to deliver safe and effective care, while also promoting innovations in procedures, medications, and technology.  Despite its strengths, the system is expensive and inefficient.  As a result, the health status of the U.S. population lags behind that of many other developed countries.  Furthermore, the system must now respond to changing conditions, including an aging population, an increase in chronic health conditions, and ongoing disparities in health outcomes that show the benefits of the healthcare system are not accessible to all.  There is a greater emphasis on primary and preventive care, along with a shift toward value-based services.

            "These changes impact the healthcare workforce.  However, this workforce faces several challenges, including a shortage of qualified practitioners, poor geographic distribution of practitioners that limits access to services, and an increasing average age of both current practitioners and the faculty who teach new students.  Meanwhile, healthcare organizations are transitioning toward an interprofessional team-based model of care, in which traditional health professionals work alongside community health workers or other providers, bringing together complementary skills toward the goal of improving patient care.  All of these factors point to an urgent need to adjust health policies, develop new methods of education, and increase investment in healthcare workforce training to promote interprofessional education and practice.

            "There has also been increasing discussion on improving training methods.  Traditional training criteria involve the completion of a set number of training hours or types of care experiences.  However, educators in many professions are examining models in which students must demonstrate their competence in fundamental skills, knowledge, and attitudes to become certified to practice.  This competency-based training allows for greater individualization in the design and evaluation of learning experiences (ACICBL, 2017)."

            The report further notes that the nation's healthcare system has traditionally focused on providing acute care within a hospital or similar clinical setting.  The aim of this approach is to preserve or restore health in the event of an illness or injury.  Acute care is, by definition, episodic and tends to treat only the current problem.  As such, it tends to be uncoordinated, inefficient, and expensive, often failing to address underlying health conditions or to help patients reduce preventable health risks.  In sharp contrast, the healthcare envisioned by President Obama's ACA, as well as the "Triple Aim" proposed by the former Administrator of the Centers for Medicare and Medicaid Services (CMS) Donald Berwick, emphasizes improving the experience of care, improving the health of populations, and reducing per capita costs simultaneously.  To succeed in this transformation, there must be a conscious shift away from traditional professional educational "silos" and equally importantly, developing respect by the next generation of practitioners for each profession's unique perspective.  To accomplish these goals, training for students in the health professions will need to incorporate the value of teamwork and include collaborative experiences with other health professionals.  This visionary approach represents a fundamental, if not unprecedented, shift in orientation from the status quo.

            APA Education Directorate's Catherine Grus: "Interprofessional training experiences should be provided to health professions students early in their training to help mitigate the formation of professional stereotypes and continue on through their clinical rotations.  It is equally important to provide opportunities for practicing health professionals to enhance their skills in interprofessional collaborative practice so that when the next generation enters the healthcare workforce they will have role models."

            Not surprisingly, ACICBL's first Policy Recommendation is: "Congress revise the eligibility requirements for Title VII, Part D, programs.  Eligibility should not be limited to specific health professions schools in isolation.  To promote interprofessional education, applicants should be permitted to develop the strongest consortia available to them, based on their access to local health professions schools, the strength of available partners, and the needs of the community."

            In a recent "letter to the editor" for a nursing journal, a director of a Nurse Practitioner program commented: "To me, the overarching health care system is like an umbrella with the different spokes representing various disciplines such as Psychology, Nursing, Social Work, Medicine, Therapies (physical, occ, rehab), Nutrition, etc.  The handle is held by and belongs to the patient as 'captain of the ship.'  After all, whose life is it anyway?"  She went on to comment on the number of times the term "medical" was used when instead should have been "health."  "I don't think nursing will be recognized as an autonomous profession until the word 'health' is substituted for 'medicine'".

            The Illinois Vision:  "With the passage by both Houses of the Illinois State Legislature of Senate Bill #2187 on May 29^th and 30^th of 2014, and the signature of then-Governor Pat Quinn on June 25, 2014, the Clinical Psychologist Licensing Act was expanded to give licensed clinical psychologists, with advanced, specialized training in Clinical Psychopharmacology and Medicine, the opportunity to apply to the Illinois Department of Financial and Professional Regulation for licensure as a 'prescribing psychologist.'  Our legislation served as a signal that Illinois was interested in repairing a broken healthcare system.  The new statute opened up access to mental health care for the most poorly served citizens throughout our state.

            "The passage of an RxP law significantly advanced the field of psychology, as we become only the fourth state (after Indiana, New Mexico and Louisiana), and the first northern, industrial state, in the nation to pass a prescriptive authority statute.  While Guam passed its RxP legislation in 1998, it is a U.S. Territory.  Iowa (2016) and Idaho (2017) quickly followed Illinois' passage.  Uniquely, in Illinois, licensed clinical psychologists, as well as psychology graduate and undergraduate students, can embark on their studies to become prescribing psychologists.  The Illinois law contains three levels of required training: * seven undergraduate basic science courses; * the Master's in Clinical Psychopharmacology with the capstone Psychopharmacology Exam for Psychologists-2 (PEP-2); and, * a series of rotations through nine medical specialties over a period of 14 months (minimum) – 28 months (maximum).

            "With the hard work and persistence of IPA leadership, staff, and a vigorous and ever-growing group of dedicated IPA members, as well as the persistence of our lobbyists, administrative attorneys, and state legislative champions (Senator President Pro-Tem, Don Harmon, in particular), the final rules for the RxP law were approved on September 12, 2017 – more than three years after SB #2187 was signed into law.

            "After spending these years implementing the tenets of our legislation, I like to say that Illinois RxP is currently in its 'toddler' stage.  There are more than 150 Illinois licensed clinical psychologists who are currently studying to become licensed prescribing psychologists.  Of those 150, at least 25 have completed their Master's degrees in Clinical Psychopharmacology as well as their required series of seven undergraduate basic science courses; have taken their capstone exam (PEP); and are now poised to enter their medical rotations.  In addition, there are 75 undergraduate psychology majors at the largest state University, the University of Illinois, Champaign-Urbana, who have chosen the 'pre-prescribing psychology' concentration, which adds the seven statute-required basic science classes to their traditional undergraduate psychology curriculum.  Major medical center and hospital systems, as well as local community hospitals, are working with us to provide the required rotation opportunities.

            "As we approach 2021, Illinois psychologists and our many third party supporters (medical center CEO's, psychiatric medical directors, social service organizations, elder care agencies, primary care physicians) will be preparing to go back to our state legislature to lobby for the removal of some of our initial statutory constraints.  Like nurse practitioners, physician assistants, and optometrists before us, the plan is for us to continue to return to the state legislature every five years until we can practice without statutory constraint.

"There is palpable excitement among our psychologist colleagues.  We have a vision of a future in which our training, our experience, and our comprehensive competencies will give us the opportunity to meet the mental and behavioral health needs of so many of our community's most underserved populations.  Our expertise is already in great demand.  Meeting that demand will give us tremendous personal and professional satisfaction (Beth Rom-Rymer)."  "You've decided that you don't want to grow anymore."  Aloha,

Pat DeLeon, former APA President – Division 55 – October, 2017

 

Sent from my iPhone

Division 55 column

“IF YOU PLAY IT SAFE IN LIFE”

A National Vision:  In December, 2013, following the service of Chairman Ron Rozensky, I was very fortunate to be appointed by Health and Human Services (HHS) Secretary Kathleen Sebelius to her Advisory Committee on Interdisciplinary, Community-Based Linkages (ACICBL), which provides policy and program development guidance for a number of the health professions training programs administered by the Health Resources and Services Administration (HRSA).  During his term as Chair of ACICBL, Ron noted that they co-signed a letter to Congress supporting the inclusion of funding for interprofessional healthcare in the Affordable Care Act (ACA) and their Annual Report to Congress stressed the importance of behavioral health integrated care.  “Having psychologists on this key federal advisory committee is an important mechanism that supports our voice being in the room when critical policy for tomorrow’s interprofessional healthcare systems is being crafted.”  This August, ACICBL issued its 15^th Annual Report to the Secretary and the U.S. Congress.  My term has now concluded; however, I am confident that rural America, our nation’s Native Americans, and psychology will be well represented by Jacqueline Gray who will continue to serve on ACICBL.

            “The United States healthcare system strives to deliver safe and effective care, while also promoting innovations in procedures, medications, and technology.  Despite its strengths, the system is expensive and inefficient.  As a result, the health status of the U.S. population lags behind that of many other developed countries.  Furthermore, the system must now respond to changing conditions, including an aging population, an increase in chronic health conditions, and ongoing disparities in health outcomes that show the benefits of the healthcare system are not accessible to all.  There is a greater emphasis on primary and preventive care, along with a shift toward value-based services.

            “These changes impact the healthcare workforce.  However, this workforce faces several challenges, including a shortage of qualified practitioners, poor geographic distribution of practitioners that limits access to services, and an increasing average age of both current practitioners and the faculty who teach new students.  Meanwhile, healthcare organizations are transitioning toward an interprofessional team-based model of care, in which traditional health professionals work alongside community health workers or other providers, bringing together complementary skills toward the goal of improving patient care.  All of these factors point to an urgent need to adjust health policies, develop new methods of education, and increase investment in healthcare workforce training to promote interprofessional education and practice.

            “There has also been increasing discussion on improving training methods.  Traditional training criteria involve the completion of a set number of training hours or types of care experiences.  However, educators in many professions are examining models in which students must demonstrate their competence in fundamental skills, knowledge, and attitudes to become certified to practice.  This competency-based training allows for greater individualization in the design and evaluation of learning experiences (ACICBL, 2017).”

            The report further notes that the nation’s healthcare system has traditionally focused on providing acute care within a hospital or similar clinical setting.  The aim of this approach is to preserve or restore health in the event of an illness or injury.  Acute care is, by definition, episodic and tends to treat only the current problem.  As such, it tends to be uncoordinated, inefficient, and expensive, often failing to address underlying health conditions or to help patients reduce preventable health risks.  In sharp contrast, the healthcare envisioned by President Obama’s ACA, as well as the “Triple Aim” proposed by the former Administrator of the Centers for Medicare and Medicaid Services (CMS) Donald Berwick, emphasizes improving the experience of care, improving the health of populations, and reducing per capita costs simultaneously.  To succeed in this transformation, there must be a conscious shift away from traditional professional educational “silos” and equally importantly, developing respect by the next generation of practitioners for each profession’s unique perspective.  To accomplish these goals, training for students in the health professions will need to incorporate the value of teamwork and include collaborative experiences with other health professionals.  This visionary approach represents a fundamental, if not unprecedented, shift in orientation from the status quo.

            APA Education Directorate’s Catherine Grus: “Interprofessional training experiences should be provided to health professions students early in their training to help mitigate the formation of professional stereotypes and continue on through their clinical rotations.  It is equally important to provide opportunities for practicing health professionals to enhance their skills in interprofessional collaborative practice so that when the next generation enters the healthcare workforce they will have role models.”

            Not surprisingly, ACICBL’s first Policy Recommendation is: “Congress revise the eligibility requirements for Title VII, Part D, programs.  Eligibility should not be limited to specific health professions schools in isolation.  To promote interprofessional education, applicants should be permitted to develop the strongest consortia available to them, based on their access to local health professions schools, the strength of available partners, and the needs of the community.”

            In a recent “letter to the editor” for a nursing journal, a director of a Nurse Practitioner program commented: “To me, the overarching health care system is like an umbrella with the different spokes representing various disciplines such as Psychology, Nursing, Social Work, Medicine, Therapies (physical, occ, rehab), Nutrition, etc.  The handle is held by and belongs to the patient as ‘captain of the ship.’  After all, whose life is it anyway?”  She went on to comment on the number of times the term “medical” was used when instead should have been “health.”  “I don’t think nursing will be recognized as an autonomous profession until the word ‘health’ is substituted for ‘medicine’”.

            The Illinois Vision:  “With the passage by both Houses of the Illinois State Legislature of Senate Bill #2187 on May 29^th and 30^th of 2014, and the signature of then-Governor Pat Quinn on June 25, 2014, the Clinical Psychologist Licensing Act was expanded to give licensed clinical psychologists, with advanced, specialized training in Clinical Psychopharmacology and Medicine, the opportunity to apply to the Illinois Department of Financial and Professional Regulation for licensure as a ‘prescribing psychologist.’  Our legislation served as a signal that Illinois was interested in repairing a broken healthcare system.  The new statute opened up access to mental health care for the most poorly served citizens throughout our state.

            “The passage of an RxP law significantly advanced the field of psychology, as we become only the fourth state (after Indiana, New Mexico and Louisiana), and the first northern, industrial state, in the nation to pass a prescriptive authority statute.  While Guam passed its RxP legislation in 1998, it is a U.S. Territory.  Iowa (2016) and Idaho (2017) quickly followed Illinois’ passage.  Uniquely, in Illinois, licensed clinical psychologists, as well as psychology graduate and undergraduate students, can embark on their studies to become prescribing psychologists.  The Illinois law contains three levels of required training: * seven undergraduate basic science courses; * the Master’s in Clinical Psychopharmacology with the capstone Psychopharmacology Exam for Psychologists-2 (PEP-2); and, * a series of rotations through nine medical specialties over a period of 14 months (minimum) – 28 months (maximum).

            “With the hard work and persistence of IPA leadership, staff, and a vigorous and ever-growing group of dedicated IPA members, as well as the persistence of our lobbyists, administrative attorneys, and state legislative champions (Senator President Pro-Tem, Don Harmon, in particular), the final rules for the RxP law were approved on September 12, 2017 – more than three years after SB #2187 was signed into law.

            “After spending these years implementing the tenets of our legislation, I like to say that Illinois RxP is currently in its ‘toddler’ stage.  There are more than 150 Illinois licensed clinical psychologists who are currently studying to become licensed prescribing psychologists.  Of those 150, at least 25 have completed their Master’s degrees in Clinical Psychopharmacology as well as their required series of seven undergraduate basic science courses; have taken their capstone exam (PEP); and are now poised to enter their medical rotations.  In addition, there are 75 undergraduate psychology majors at the largest state University, the University of Illinois, Champaign-Urbana, who have chosen the ‘pre-prescribing psychology’ concentration, which adds the seven statute-required basic science classes to their traditional undergraduate psychology curriculum.  Major medical center and hospital systems, as well as local community hospitals, are working with us to provide the required rotation opportunities.

            “As we approach 2021, Illinois psychologists and our many third party supporters (medical center CEO’s, psychiatric medical directors, social service organizations, elder care agencies, primary care physicians) will be preparing to go back to our state legislature to lobby for the removal of some of our initial statutory constraints.  Like nurse practitioners, physician assistants, and optometrists before us, the plan is for us to continue to return to the state legislature every five years until we can practice without statutory constraint.

“There is palpable excitement among our psychologist colleagues.  We have a vision of a future in which our training, our experience, and our comprehensive competencies will give us the opportunity to meet the mental and behavioral health needs of so many of our community’s most underserved populations.  Our expertise is already in great demand.  Meeting that demand will give us tremendous personal and professional satisfaction (Beth Rom-Rymer).”  “You’ve decided that you don’t want to grow anymore.”  Aloha,

Pat DeLeon, former APA President – Division 55 – October, 2017

 

 

TRANSFORMATIONAL VISION

Former APA President Nick Cummings frequently called for organized psychology to develop "homes of their own" where they would be administratively and clinically responsible for providing quality, integrated behavioral healthcare.  Finding psychology generally unresponsive at that time, Nick ultimately established the managed care behavioral health organization Biodyne, which covered 37 million Americans, with 10,000 employees in all 50 states and the District of Columbia.   Those with an historical perspective will appreciate that Nick's vision was shared by David Rogers at the Cleveland Clinic, whom the Ohio Psychological Association honored in 2000 with their Lifetime Achievement Award.  Similarly, over the years, Dennis Freeman has also taken this message to heart, administering cutting-edge behavioral healthcare at Cherokee Health Systems in Tennessee.  Those fortunate to attend our exciting 125^th annual convention earlier this year, under the leadership of President Tony Puente, were exposed to a wide range of programmatic initiatives demonstrating that psychology has finally come to appreciate Nick's wisdom in conceptualizing psychology as one of the bona fide health professions and the importance of providing proactive leadership.

            In 2005, Psychologist Barbara Van Dahlen founded Give an Hour which provides free mental health care to those who serve in the military, our Veterans, and their families.  Collectively, generous volunteer mental health professionals of all disciplines have donated over 124,000 hours of free care and support, valued at nearly $23 million.  Barbara appreciates that those whom the VA ultimately serve come from the military and accordingly, she has been extremely supportive of including students and faculty from the Uniformed Services University (USU) in her programmatic efforts, and personally participating in USU seminars.  This Fall she extended invitations to attend her special Sirius XM radio broadcast with VA Secretary David Shulkin in recognition of Suicide Prevention Month – "The Department of Veterans Affairs' Role in Changing the Culture of Mental Health."

            During their fascinating one hour discussion, the Secretary covered a number of topics that are highly relevant to public service colleagues.  On a personal level, several members of his immediate family possess psychology and pharmacy backgrounds, thus enhancing his appreciation for how important interdisciplinary, integrated care can be.  He reiterated his commitment to providing timely access to behavioral health care, including his support for utilizing tele-mental health services.  Both of these efforts are also high priorities for the current U.S. Army Surgeon General Nadja West.  Having recently watched the moving film documentary Served Like a Girl, in which the plight of an estimated 50,000 female Veterans with children experience minimum support from the VA, we were particularly pleased with the Secretary's commitment to serving this unique population, in response to Barbara's question about female Veterans.  He was also quite candid about the need to appreciate how a mental health crisis can adversely impact one's discharge status and that necessary behavioral healthcare must be provided.

            "I appreciated Secretary Shulkin's sincerity, and his background as an internal medicine physician was evident in how he prioritized his objectives for the VA.  He recognizes that some crises require immediate attention to mitigate further deterioration – just like in his former patients.  He shared one statistic that was particularly shocking.  From 2001 to 2014, the suicide rate among female Veterans who were not being treated by the VA went up 85%.  Conversely, the suicide rate among female Veterans who were being treated by the VA went down 2%.  It follows that access to care is a major roadblock that must be addressed immediately.  He further recognizes that all of our Veterans need timely, effective, and compassionate care -- THIS is a priority.  One innovative solution may be auto-enrollment, whereby if a Veteran doesn't choose an alternative healthcare plan, he or she will be auto-enrolled in the VA system.  Then, if a health crisis arises, the Veteran doesn't have to worry about the administrative delay of getting enrolled.  Likewise, he enacted VA coverage for emergency mental health services for ALL Veterans (not just those with honorable discharges) as of July 1, 2017.  This is a critical step in decreasing the suicide rate among Veterans, especially those who were dishonorably discharged due to a behavior that stemmed from unresolved mental health conditions.  I believe Secretary Shulkin is steering VA down the right path – towards timely, effective care and wellness for ALL Veterans" [USAF Capt. Michelle Binder, USU Doctor of Nursing Practice (DNP) student].

            APA's new Director of Military and Veterans Health Policy, Heather O'Beirne Kelly, was delighted to sit in the studio audience for Barbara's Sirius XM conversation with Secretary Shulkin.  "Barbara's interview was wonderful, and has the power to reach so many Veterans and mental health providers through Sirius XM.  APA shares the Secretary's priority for decreasing the troubling rates of suicide among Veterans, and subgroups of Veterans like older cohorts, women, and those with other than honorable discharges.  We applaud his moves to open up emergent care to Veterans with so-called 'bad paper,' and to focus on getting evidence-based treatments to Veterans far upstream, before they're in crisis, while also strengthening the VA's capacity to effectively reach and work with Veterans in crisis through the crisis line, same day service in VA medical centers, and integrated primary care.  We are proud of APA's collaboration with Barbara and Give an Hour, and our advocacy to garner Congressional support for a strong, well-resourced VA."

            "That same evening Give an Hour and their Campaign to Change Direction hosted a packed movie screening of the new film, Rebel in the Rye, about the life of J.D. Salinger, the author of 'Catcher in the Rye.'  The film particularly highlighted Salinger's post-traumatic stress reactions from fighting in World War II and surviving the D-day invasion.  After returning from the war and following his remarkable success at a writer, Salinger was portrayed as struggling with trusting others, leading him to isolate himself from the world.  This isolation, combined with his fixation on healing himself through various religious and meditative practices, negatively impacted his relationship with his family and friends.  Rebel in the Rye strives to contribute to increasing public awareness of how war affects the mental health of Veterans.  Public awareness of post-traumatic stress disorder (PTSD) is particularly important as we see the effects of war on an influx of Veterans from the wars in Iraq and Afghanistan, while continuing to care for Vietnam Veterans" (Joanna Sells, USU Medical & Clinical Psychology graduate student).

Give an Hour's successful model is being expanded to address the mental health concerns of other populations who are also clearly in need -- including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.  They have opened their network in response to the trauma in Charlottesville and most recently are partnering with the Red Cross to respond to the unprecedented devastation due to Hurricanes Harvey and Irma.

            Labor, Health and Human Services, and Education FY 2018 Appropriations bill – The U.S. Senate Appropriations Committee recommended HHS continue to provide support for the Graduate Psychology Education Program (GPE).  "The Committee recognizes the growing need for highly trained behavioral health professionals to deliver evidence-based services to vulnerable populations, including the elderly, returning military Veterans, and those suffering from trauma.  The GPE program is the main Federal initiative dedicated to the education and training of psychologists.  The Committee urges HRSA to explore evidence-based approaches to leverage workforce capacity through this program, to invest in geropsychology training programs, and to help integrate health service psychology trainees at Federally Qualified Health Centers."  Our special thanks to former Interim APA CEO Cynthia Belar, who, in her earlier capacity as Director of the Education Directorate, made the GPE initiative a high personal priority.

Psychological Services – Public service colleagues work in a fascinating variety of positions.  Under the leadership of Editors Femina Varghese and Gary VandenBos, the Division's journal will be highlighting several of these during the coming months.  We expect, for example, to hear from those serving on a U.S. Navy aircraft carrier and/or submarine, responding to the extraordinary trauma resulting from national disasters, and the unique opportunities evolving from the APA Congressional and Administration Fellowship program.  "We celebrate the past to awaken the future."  Aloha,

Pat DeLeon, former APA President – Division 18 – September, 2017

Cummings, N. A., & VandenBos, G. R. (1979).  The general practice of psychology. Professional Psychology, 10(4), 430-440.

 

Sent from my iPhone

ALOHA - D18 column

TRANSFORMATIONAL VISION

            Former APA President Nick Cummings frequently called for organized psychology to develop “homes of their own” where they would be administratively and clinically responsible for providing quality, integrated behavioral healthcare.  Finding psychology generally unresponsive at that time, Nick ultimately established the managed care behavioral health organization Biodyne, which covered 37 million Americans, with 10,000 employees in all 50 states and the District of Columbia.   Those with an historical perspective will appreciate that Nick’s vision was shared by David Rogers at the Cleveland Clinic, whom the Ohio Psychological Association honored in 2000 with their Lifetime Achievement Award.  Similarly, over the years, Dennis Freeman has also taken this message to heart, administering cutting-edge behavioral healthcare at Cherokee Health Systems in Tennessee.  Those fortunate to attend our exciting 125^th annual convention earlier this year, under the leadership of President Tony Puente, were exposed to a wide range of programmatic initiatives demonstrating that psychology has finally come to appreciate Nick’s wisdom in conceptualizing psychology as one of the bona fide health professions and the importance of providing proactive leadership.

            In 2005, Psychologist Barbara Van Dahlen founded Give an Hour which provides free mental health care to those who serve in the military, our Veterans, and their families.  Collectively, generous volunteer mental health professionals of all disciplines have donated over 124,000 hours of free care and support, valued at nearly $23 million.  Barbara appreciates that those whom the VA ultimately serve come from the military and accordingly, she has been extremely supportive of including students and faculty from the Uniformed Services University (USU) in her programmatic efforts, and personally participating in USU seminars.  This Fall she extended invitations to attend her special Sirius XM radio broadcast with VA Secretary David Shulkin in recognition of Suicide Prevention Month – “The Department of Veterans Affairs’ Role in Changing the Culture of Mental Health.”

            During their fascinating one hour discussion, the Secretary covered a number of topics that are highly relevant to public service colleagues.  On a personal level, several members of his immediate family possess psychology and pharmacy backgrounds, thus enhancing his appreciation for how important interdisciplinary, integrated care can be.  He reiterated his commitment to providing timely access to behavioral health care, including his support for utilizing tele-mental health services.  Both of these efforts are also high priorities for the current U.S. Army Surgeon General Nadja West.  Having recently watched the moving film documentary Served Like a Girl, in which the plight of an estimated 50,000 female Veterans with children experience minimum support from the VA, we were particularly pleased with the Secretary’s commitment to serving this unique population, in response to Barbara’s question about female Veterans.  He was also quite candid about the need to appreciate how a mental health crisis can adversely impact one’s discharge status and that necessary behavioral healthcare must be provided.

            “I appreciated Secretary Shulkin’s sincerity, and his background as an internal medicine physician was evident in how he prioritized his objectives for the VA.  He recognizes that some crises require immediate attention to mitigate further deterioration – just like in his former patients.  He shared one statistic that was particularly shocking.  From 2001 to 2014, the suicide rate among female Veterans who were not being treated by the VA went up 85%.  Conversely, the suicide rate among female Veterans who were being treated by the VA went down 2%.  It follows that access to care is a major roadblock that must be addressed immediately.  He further recognizes that all of our Veterans need timely, effective, and compassionate care -- THIS is a priority.  One innovative solution may be auto-enrollment, whereby if a Veteran doesn’t choose an alternative healthcare plan, he or she will be auto-enrolled in the VA system.  Then, if a health crisis arises, the Veteran doesn’t have to worry about the administrative delay of getting enrolled.  Likewise, he enacted VA coverage for emergency mental health services for ALL Veterans (not just those with honorable discharges) as of July 1, 2017.  This is a critical step in decreasing the suicide rate among Veterans, especially those who were dishonorably discharged due to a behavior that stemmed from unresolved mental health conditions.  I believe Secretary Shulkin is steering VA down the right path – towards timely, effective care and wellness for ALL Veterans” [USAF Capt. Michelle Binder, USU Doctor of Nursing Practice (DNP) student].

            APA’s new Director of Military and Veterans Health Policy, Heather O’Beirne Kelly, was delighted to sit in the studio audience for Barbara’s Sirius XM conversation with Secretary Shulkin.  “Barbara’s interview was wonderful, and has the power to reach so many Veterans and mental health providers through Sirius XM.  APA shares the Secretary’s priority for decreasing the troubling rates of suicide among Veterans, and subgroups of Veterans like older cohorts, women, and those with other than honorable discharges.  We applaud his moves to open up emergent care to Veterans with so-called ‘bad paper,’ and to focus on getting evidence-based treatments to Veterans far upstream, before they’re in crisis, while also strengthening the VA’s capacity to effectively reach and work with Veterans in crisis through the crisis line, same day service in VA medical centers, and integrated primary care.  We are proud of APA’s collaboration with Barbara and Give an Hour, and our advocacy to garner Congressional support for a strong, well-resourced VA.”

            “That same evening Give an Hour and their Campaign to Change Direction hosted a packed movie screening of the new film, Rebel in the Rye, about the life of J.D. Salinger, the author of ‘Catcher in the Rye.’  The film particularly highlighted Salinger’s post-traumatic stress reactions from fighting in World War II and surviving the D-day invasion.  After returning from the war and following his remarkable success at a writer, Salinger was portrayed as struggling with trusting others, leading him to isolate himself from the world.  This isolation, combined with his fixation on healing himself through various religious and meditative practices, negatively impacted his relationship with his family and friends.  Rebel in the Rye strives to contribute to increasing public awareness of how war affects the mental health of Veterans.  Public awareness of post-traumatic stress disorder (PTSD) is particularly important as we see the effects of war on an influx of Veterans from the wars in Iraq and Afghanistan, while continuing to care for Vietnam Veterans” (Joanna Sells, USU Medical & Clinical Psychology graduate student).

Give an Hour’s successful model is being expanded to address the mental health concerns of other populations who are also clearly in need -- including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.  They have opened their network in response to the trauma in Charlottesville and most recently are partnering with the Red Cross to respond to the unprecedented devastation due to Hurricanes Harvey and Irma.

            Labor, Health and Human Services, and Education FY 2018 Appropriations bill – The U.S. Senate Appropriations Committee recommended HHS continue to provide support for the Graduate Psychology Education Program (GPE).  “The Committee recognizes the growing need for highly trained behavioral health professionals to deliver evidence-based services to vulnerable populations, including the elderly, returning military Veterans, and those suffering from trauma.  The GPE program is the main Federal initiative dedicated to the education and training of psychologists.  The Committee urges HRSA to explore evidence-based approaches to leverage workforce capacity through this program, to invest in geropsychology training programs, and to help integrate health service psychology trainees at Federally Qualified Health Centers.”  Our special thanks to former Interim APA CEO Cynthia Belar, who, in her earlier capacity as Director of the Education Directorate, made the GPE initiative a high personal priority.

Psychological Services – Public service colleagues work in a fascinating variety of positions.  Under the leadership of Editors Femina Varghese and Gary VandenBos, the Division’s journal will be highlighting several of these during the coming months.  We expect, for example, to hear from those serving on a U.S. Navy aircraft carrier and/or submarine, responding to the extraordinary trauma resulting from national disasters, and the unique opportunities evolving from the APA Congressional and Administration Fellowship program.  “We celebrate the past to awaken the future.”  Aloha,

Pat DeLeon, former APA President – Division 18 – September, 2017

Cummings, N. A., & VandenBos, G. R. (1979).  The general practice of psychology. Professional Psychology, 10(4), 430-440.

 

INTRIGUING ISSUES TO BE ADDRESSED

September is Suicide Prevention Month.  All of our State Psychological Associations have members who currently serve in the military, are Veterans, or members of military families.  VA Secretary David Shulkin: "We know that in 2014, an average of 20 Veterans a day died in this country from suicide, which is 20 too many.  This is a national public health crisis requiring a national public health approach.  When it comes to preventing Veteran suicide, VA can't – and should not – do this alone."  In 2005, over 12 years ago, Psychologist Barbara Van Dahlen founded Give an Hour which has since provided free mental health care to those who serve, our Veterans, and their families.  Collectively, generous volunteer mental health professionals have donated over 124,000 hours of free care and support, valued at nearly $23 million.  Most recently, this impressive organization has partnered with the Red Cross to respond to the unprecedented devastation on the Gulf Coast as a result of Hurricane Harvey and Irma.  Their model has been proven and is being expanded to now address the mental health concerns of other populations in need -- including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.  Has your State Association partnered with Give an Hour and more importantly, have you volunteered?

Scope of Practice Issues -- The Times They Are A-Changin':  Those who attended the exciting 125^th annual APA Convention may have been exposed to several far reaching policy discussions (including on the floor of Council) regarding telehealth and what psychology's position should be on the increasingly expanding role of master's trained mental health clinicians.  Members of the Education and Practice Directorate and the Board of Directors coordinated a recent Masters Summit, sponsored by the APA Minority Fellowship Program, during which 32 members of the APA governance actively participated.  Those in attendance represented practice, education and training, public and private sector psychology, the VA and other hospital settings; as well as additional identifiable stakeholders, including other disciplines.  President Tony Puente's overview: "The Council addressed a complicated issue that has eluded successful resolution by the discipline of psychology over more than 70 years, agreeing by acclamation that 'current issues and developments have risen to the level that APA should take a position on master's level training and/or practice….'  Further action is expected on this issue in February."

From a broader policy perspective, 22 states and the District of Columbia now have enacted full practice authority for their advanced practice nurses.  Pursuant to Congressional direction, in the near future, the Departments of Defense and Veterans Affairs will be exploring the training and utilization of Physician Assistants (PAs), specially trained in mental health.  Those colleagues working within integrated care models, especially where visionary leaders from Colleges of Pharmacy have been involved, will appreciate that there are an increasing number of Clinical Pharmacists who are specializing in the appropriate utilization of psychotropic medications, as well as the psychosocial-economic-cultural gradient of "quality care."  Addressing efforts to "repeal and replace Obamacare," the former White House Director of Economic Policy under President George H.W. Bush recently proffered: "State governments should give greater authority to nurse practitioners and physician assistants to open their own practices and encourage walk-in clinics."  Has your State Association partnered with your local State Pharmacy, Nursing, or Physician Assistant Associations in developing joint CE programming?  "The future ain't what it used to be."  Aloha,

Pat DeLeon, former APA President – Division 31 – September, 2017

 

Sent from my iPhone

Division 31 Fall column

INTRIGUING ISSUES TO BE ADDRESSED

September is Suicide Prevention Month.  All of our State Psychological Associations have members who currently serve in the military, are Veterans, or members of military families.  VA Secretary David Shulkin: “We know that in 2014, an average of 20 Veterans a day died in this country from suicide, which is 20 too many.  This is a national public health crisis requiring a national public health approach.  When it comes to preventing Veteran suicide, VA can’t – and should not – do this alone.”  In 2005, over 12 years ago, Psychologist Barbara Van Dahlen founded Give an Hour which has since provided free mental health care to those who serve, our Veterans, and their families.  Collectively, generous volunteer mental health professionals have donated over 124,000 hours of free care and support, valued at nearly $23 million.  Most recently, this impressive organization has partnered with the Red Cross to respond to the unprecedented devastation on the Gulf Coast as a result of Hurricane Harvey and Irma.  Their model has been proven and is being expanded to now address the mental health concerns of other populations in need -- including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.  Has your State Association partnered with Give an Hour and more importantly, have you volunteered?

Scope of Practice Issues -- The Times They Are A-Changin’:  Those who attended the exciting 125^th annual APA Convention may have been exposed to several far reaching policy discussions (including on the floor of Council) regarding telehealth and what psychology’s position should be on the increasingly expanding role of master’s trained mental health clinicians.  Members of the Education and Practice Directorate and the Board of Directors coordinated a recent Masters Summit, sponsored by the APA Minority Fellowship Program, during which 32 members of the APA governance actively participated.  Those in attendance represented practice, education and training, public and private sector psychology, the VA and other hospital settings; as well as additional identifiable stakeholders, including other disciplines.  President Tony Puente’s overview: “The Council addressed a complicated issue that has eluded successful resolution by the discipline of psychology over more than 70 years, agreeing by acclamation that ‘current issues and developments have risen to the level that APA should take a position on master’s level training and/or practice….’  Further action is expected on this issue in February.”

From a broader policy perspective, 22 states and the District of Columbia now have enacted full practice authority for their advanced practice nurses.  Pursuant to Congressional direction, in the near future, the Departments of Defense and Veterans Affairs will be exploring the training and utilization of Physician Assistants (PAs), specially trained in mental health.  Those colleagues working within integrated care models, especially where visionary leaders from Colleges of Pharmacy have been involved, will appreciate that there are an increasing number of Clinical Pharmacists who are specializing in the appropriate utilization of psychotropic medications, as well as the psychosocial-economic-cultural gradient of “quality care.”  Addressing efforts to “repeal and replace Obamacare,” the former White House Director of Economic Policy under President George H.W. Bush recently proffered: “State governments should give greater authority to nurse practitioners and physician assistants to open their own practices and encourage walk-in clinics.”  Has your State Association partnered with your local State Pharmacy, Nursing, or Physician Assistant Associations in developing joint CE programming?  “The future ain’t what it used to be.”  Aloha,

Pat DeLeon, former APA President – Division 31 – September, 2017