FLY DOWN THE HIGHWAY

The Department of Veterans Affairs (VA):  The VA is the largest employer of psychologists and nurses and over the years, has done an outstanding job of providing high quality health care while simultaneously furthering the utilization of non-physician providers of all disciplines.  Thanks to the vision of Toni and Bob Zeiss and the support of Ken Jones the VA, which has long supported psychology internships, is expected to provide approximately 440 postdoctoral positions in the coming academic year.  This spring the VA proposed to amend its regulations to permit full practice authority for advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.  "This would permit VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA."  At the closing of the public comment period on July 25^th, over 214,000 comments had been received.  The AMA urged the VA: "to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes."  One political pundit opined that the AMA had as much credibility on this issue as the NRA did on gun control.

            Under the leadership of APA immediate Past-President Barry Anton and President-elect Tony Puente, 16 former APA Presidents submitted a letter in support of the VA's proposal.  "Dear Mr. Secretary:  As former Presidents of the American Psychological Association (APA), the nation's largest organization of psychologists with over 117,000 members, we urge you to ensure that the Department of Veterans Affairs (VA) allows its professional staff to work to the full scope of their practice to improve access to timely, effective, high-quality care for Veterans.  We, and the current leadership of APA, believe that expanding prescriptive authority within the VA for qualified nurses and doctoral-level psychologists is a fundamental and urgent component of a redesigned, improved 'MyVA' integrated plan.

            "One of the key recommendations from the landmark Institute of Medicine (IOM) report 'The Future of Nursing' stated that 'nurses should practice to the full extent of their education and training.'  As colleagues equally committed to providing care for Veterans both inside and outside the VA system, we concur with the IOM that 'nurses can and should play a fundamental role' in transforming care in this country, and that 'the power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses; government, businesses, health care organizations, professional associations, and the insurance industry must all play a role.  Working together, these many diverse parties can help ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes.'  Mr. Secretary, you have been instrumental in keeping the VA focused on what is best for the Veteran, and we believe that to do so requires the VA to ensure that its clinical staff is operating at its highest capacity.

"In a similar vein, we expect that the VA also will soon make the internal policy changes necessary to recognize prescriptive authority for appropriately trained and certified psychologists within the VA system.  The Department of Defense (DoD) has granted this authority to its specialized psychologists for over 18 years, with zero adverse effects or complaints during this entire period.  The US Public Health Service Commissioned Corps similarly allows psychologists with specific training beyond their doctoral degrees to prescribe a set of medications and meet the urgent needs of their populations, which include citizens in Indian Country.  Illinois became the latest state to grant this authority to psychologists with additional degrees in psychopharmacology and certification.  It is clear that the VA, in the face of increasing demand for mental health care and recognized access difficulties in rural areas specifically, must remain a pioneer in the health care arena by allowing nurse practitioners and psychologists to serve Veterans with the expertise and dedication they employ in the DoD, USPHS, and private sectors.

"We would be happy to meet with you and your Undersecretary of Health, Dr. David Shulkin, to discuss the implementation of prescriptive authority within the VA…."  Two additional Presidential colleagues requested being added to the letter; however, the submission date had already passed.  Our sincerest appreciation to APA's Heather O'Beirne Kelly for her outstanding assistance in making our collective voice heard on behalf of our nation's Veterans.

            A similarly supportive endorsement was submitted by Dr. Lucinda Maine, Executive VP and CEO of the American Association of Colleges of Pharmacy.  "The American Association of Colleges of Pharmacy (AACP) appreciates the opportunity to comment on the proposed regulation… and is supportive of the proposal to 'permit full practice authority for all Veterans Administration advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.'  We draw upon significant experience with advanced practice authority for pharmacists and other health care providers in preparing these comments.

            "AACP recognizes that APRNs are increasingly important providers of primary care services in the non-VA health care sector and applauds the VA for integrating these skilled health professionals into the VHA.  We view this as an excellent opportunity to 'wisely manage its resources and fully utilize the skills of its health care providers to the full extent of their education, training and certification.'  We support the VA taking the initiative to 'establish additional professional qualifications an individual must possess to be appointed as an APRN with VA.'  The VA's proposal to standardize the APRN full practice authority by reducing the confounding factor of state regulation is an important step that allows for more consistent management of patient, provider and administrator expectations within the VHA.  This action is an important step in increasing patient access to primary care services, especially, as you recognize, in medically underserved areas.

            "AACP is a strong proponent of patient-centered team-based care.  As a founding member of the Interprofessional Education Collaborative (IPEC) we have worked closely with our colleagues across academic medicine, nursing, dentistry and public health to teach future health professionals how to most effectively work together.  Quite recently the IPEC organization expanded to include 9 additional health professions education associations.  As this includes the Association of Schools of Allied Health Professions, IPEC now includes virtually all the health disciplines.  Optimizing the deployment of every clinician is the only pathway to insuring access to care for all, especially special populations like veterans who so often are in rural or otherwise underserved communities.  Translating this work into the care delivery systems our graduates will serve is also a high priority for IPEC.

            "AACP shares the VA's concern about the timely provision of high-quality care, particularly primary care, by qualified healthcare professionals in locations readily accessible to the larger percentage of veterans.  Towards that end, AACP also encourages the VA to consider proposing a similar set of rules for pharmacists.  Like APRNs, pharmacists in the VHA are subject to the congressionally mandated qualifications.  The VA… is authorized to regulate the professional activities and establish qualifications and conditions of employment of pharmacists as it does APRNs.  Your proposal reflects a model that is well established in the Indian Health Service where guidance was issued in 1996 regarding designating pharmacists as primary care providers with prescriptive authority (Special General Memorandum 96-2).

            "The VHA has been a valued partner with academic pharmacy for decades and VA leadership recognizes the value pharmacists add to the health care team through their collaborative approach to patient care.  The Patient Aligned Care Team (PACT) provides ample evidence that pharmacists provide great, and could provide even greater, value to veterans and other members of the primary care team if they were consistently supported and privileged in a manner similar to that proposed in this rule for APRNs.

            "With an academy of researchers and practitioners focused on care improvement and team-based care, AACP offers the VA the opportunity to initiate a discussion that can create even greater support for and value in the proposed rules related to APRNs through collaboration with pharmacists and other non-physician providers that are authorized with 'full practice authority.'"  A particularly significant supportive communication also came from the Federal Trade Commission (FTC).

            Interesting Reflections:  "The year was 1988 – now 28 years ago – and I had been appointed as Chief, Behavioral Health Services at the PHS/IHS Santa Fe Service Unit, in Santa Fe, New Mexico.  Limited, dependent prescriptive privileges (RxP) were granted to me by the Medical Director; i.e., a limited formulary excluding scheduled drugs, and dependent upon his supervision.  I had the support of the IHS Albuquerque area psychiatrist with whom I spoke regarding every case; review and support was granted by the New Mexico Psychological Association ethics committee.  Slightly less than two years later I was to leave that post – by which time, after being invited to speak before the U.S. Senate Committee on Indian Affairs, thousands of letters of complaint had been sent to the Medical Director of IHS by psychiatrists across the nation, though over three hundred patients had been seen, with no adverse effects (and with enormous support from the physicians working in IHS).  Note that in the years subsequent, there has been no nimiety of psychiatric physicians seeking to work or even volunteer in those pueblos of the Albuquerque area!

            "From those turbulent beginnings, and due both to vision and persistence, psychologists have been given authority to exercise prescriptive privileges in Iowa, Illinois, New Mexico, and Louisiana, as well as in the Public Health Service, the U.S. military, and Guam.  A cursory look at the New Mexico Board of Psychologist Examiners website reveals 40 names of persons with active certification as prescribing psychologists.  Though by no means thorough, an internet search turns up approximately 11 who are in PHS/IHS, state or federal agencies, or mental health facilities.  Many psychologists having national prominence in this area have now completed careers in federal services in the almost 30 years since those days in PHS/IHS.  We have indeed 'come a long way!'

            "Yet there is much to be done.  For example, in Texas alone, 185 of the 254 counties have no psychiatrist.  Nurse Practitioners have been quite successful in extending their scope of practice to include prescriptive privileges – in many venues.  In fact, the future of primary care may well transfer to nurse practitioners, with the increasing specialization of medicine and the decreased number of young persons seeking careers in primary medicine, where reimbursement rates are far less than in high technology.  Yet, in Texas, and in many other states, the likelihood of expanding the scope of practice for psychology is not great.  I argue that is far more likely to occur when the basis is need (rather than greed).  Wouldn't it be interesting if there were many programs to train psychologists to prescribe – at no cost to the person – in return for a two-year commitment to work in an underserved area?  Wouldn't it be exciting if there were a national recognition of the absolute necessity to increase the array of health resources in now underserved areas – of which psychology could be a part?  At 75, I expect that I shall not live to see it, but I can dream, can't I? (Floyd Jennings)."  Ray Folen, Executive Director of the Hawaii Psychological Association: "Over the last 10 years while at Tripler Army Medical Center I had written 3,178 prescriptions and my colleague Mike Kellar had written 5,780.  No adverse events."  Psychology prides itself on being one of the learned professions.  Yet, whenever Beth Rom-Rymer provides an update on the exciting implementation of her Illinois success, one of our largest Divisions declines to publish her comments on their e-mail list serve; notwithstanding that RxP is APA policy.  "Our progeny have stars in their eyes.  Let's help them realize their dreams (Beth)."  Perhaps this Division hopes to protect their membership from the future?  "You don't know what I've done."  Aloha,

Pat DeLeon, former APA President – Division 29 – August, 2016

 

Sent from my iPhone

Division 29 August column

“FLY DOWN THE HIGHWAY”

            The Department of Veterans Affairs (VA):  The VA is the largest employer of psychologists and nurses and over the years, has done an outstanding job of providing high quality health care while simultaneously furthering the utilization of non-physician providers of all disciplines.  Thanks to the vision of Toni and Bob Zeiss and the support of Ken Jones the VA, which has long supported psychology internships, is expected to provide approximately 440 postdoctoral positions in the coming academic year.  This spring the VA proposed to amend its regulations to permit full practice authority for advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.  “This would permit VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA.”  At the closing of the public comment period on July 25^th, over 214,000 comments had been received.  The AMA urged the VA: “to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes.”  One political pundit opined that the AMA had as much credibility on this issue as the NRA did on gun control.

            Under the leadership of APA immediate Past-President Barry Anton and President-elect Tony Puente, 16 former APA Presidents submitted a letter in support of the VA’s proposal.  “Dear Mr. Secretary:  As former Presidents of the American Psychological Association (APA), the nation’s largest organization of psychologists with over 117,000 members, we urge you to ensure that the Department of Veterans Affairs (VA) allows its professional staff to work to the full scope of their practice to improve access to timely, effective, high-quality care for Veterans.  We, and the current leadership of APA, believe that expanding prescriptive authority within the VA for qualified nurses and doctoral-level psychologists is a fundamental and urgent component of a redesigned, improved ‘MyVA’ integrated plan.

            “One of the key recommendations from the landmark Institute of Medicine (IOM) report ‘The Future of Nursing’ stated that ‘nurses should practice to the full extent of their education and training.’  As colleagues equally committed to providing care for Veterans both inside and outside the VA system, we concur with the IOM that ‘nurses can and should play a fundamental role’ in transforming care in this country, and that ‘the power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses; government, businesses, health care organizations, professional associations, and the insurance industry must all play a role.  Working together, these many diverse parties can help ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes.’  Mr. Secretary, you have been instrumental in keeping the VA focused on what is best for the Veteran, and we believe that to do so requires the VA to ensure that its clinical staff is operating at its highest capacity.

“In a similar vein, we expect that the VA also will soon make the internal policy changes necessary to recognize prescriptive authority for appropriately trained and certified psychologists within the VA system.  The Department of Defense (DoD) has granted this authority to its specialized psychologists for over 18 years, with zero adverse effects or complaints during this entire period.  The US Public Health Service Commissioned Corps similarly allows psychologists with specific training beyond their doctoral degrees to prescribe a set of medications and meet the urgent needs of their populations, which include citizens in Indian Country.  Illinois became the latest state to grant this authority to psychologists with additional degrees in psychopharmacology and certification.  It is clear that the VA, in the face of increasing demand for mental health care and recognized access difficulties in rural areas specifically, must remain a pioneer in the health care arena by allowing nurse practitioners and psychologists to serve Veterans with the expertise and dedication they employ in the DoD, USPHS, and private sectors.

“We would be happy to meet with you and your Undersecretary of Health, Dr. David Shulkin, to discuss the implementation of prescriptive authority within the VA….”  Two additional Presidential colleagues requested being added to the letter; however, the submission date had already passed.  Our sincerest appreciation to APA’s Heather O’Beirne Kelly for her outstanding assistance in making our collective voice heard on behalf of our nation’s Veterans.

            A similarly supportive endorsement was submitted by Dr. Lucinda Maine, Executive VP and CEO of the American Association of Colleges of Pharmacy.  “The American Association of Colleges of Pharmacy (AACP) appreciates the opportunity to comment on the proposed regulation… and is supportive of the proposal to ‘permit full practice authority for all Veterans Administration advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.’  We draw upon significant experience with advanced practice authority for pharmacists and other health care providers in preparing these comments.

            “AACP recognizes that APRNs are increasingly important providers of primary care services in the non-VA health care sector and applauds the VA for integrating these skilled health professionals into the VHA.  We view this as an excellent opportunity to ‘wisely manage its resources and fully utilize the skills of its health care providers to the full extent of their education, training and certification.’  We support the VA taking the initiative to ‘establish additional professional qualifications an individual must possess to be appointed as an APRN with VA.’  The VA’s proposal to standardize the APRN full practice authority by reducing the confounding factor of state regulation is an important step that allows for more consistent management of patient, provider and administrator expectations within the VHA.  This action is an important step in increasing patient access to primary care services, especially, as you recognize, in medically underserved areas.

            “AACP is a strong proponent of patient-centered team-based care.  As a founding member of the Interprofessional Education Collaborative (IPEC) we have worked closely with our colleagues across academic medicine, nursing, dentistry and public health to teach future health professionals how to most effectively work together.  Quite recently the IPEC organization expanded to include 9 additional health professions education associations.  As this includes the Association of Schools of Allied Health Professions, IPEC now includes virtually all the health disciplines.  Optimizing the deployment of every clinician is the only pathway to insuring access to care for all, especially special populations like veterans who so often are in rural or otherwise underserved communities.  Translating this work into the care delivery systems our graduates will serve is also a high priority for IPEC.

            “AACP shares the VA’s concern about the timely provision of high-quality care, particularly primary care, by qualified healthcare professionals in locations readily accessible to the larger percentage of veterans.  Towards that end, AACP also encourages the VA to consider proposing a similar set of rules for pharmacists.  Like APRNs, pharmacists in the VHA are subject to the congressionally mandated qualifications.  The VA… is authorized to regulate the professional activities and establish qualifications and conditions of employment of pharmacists as it does APRNs.  Your proposal reflects a model that is well established in the Indian Health Service where guidance was issued in 1996 regarding designating pharmacists as primary care providers with prescriptive authority (Special General Memorandum 96-2).

            “The VHA has been a valued partner with academic pharmacy for decades and VA leadership recognizes the value pharmacists add to the health care team through their collaborative approach to patient care.  The Patient Aligned Care Team (PACT) provides ample evidence that pharmacists provide great, and could provide even greater, value to veterans and other members of the primary care team if they were consistently supported and privileged in a manner similar to that proposed in this rule for APRNs.

            “With an academy of researchers and practitioners focused on care improvement and team-based care, AACP offers the VA the opportunity to initiate a discussion that can create even greater support for and value in the proposed rules related to APRNs through collaboration with pharmacists and other non-physician providers that are authorized with ‘full practice authority.’”  A particularly significant supportive communication also came from the Federal Trade Commission (FTC).

            Interesting Reflections:  “The year was 1988 – now 28 years ago – and I had been appointed as Chief, Behavioral Health Services at the PHS/IHS Santa Fe Service Unit, in Santa Fe, New Mexico.  Limited, dependent prescriptive privileges (RxP) were granted to me by the Medical Director; i.e., a limited formulary excluding scheduled drugs, and dependent upon his supervision.  I had the support of the IHS Albuquerque area psychiatrist with whom I spoke regarding every case; review and support was granted by the New Mexico Psychological Association ethics committee.  Slightly less than two years later I was to leave that post – by which time, after being invited to speak before the U.S. Senate Committee on Indian Affairs, thousands of letters of complaint had been sent to the Medical Director of IHS by psychiatrists across the nation, though over three hundred patients had been seen, with no adverse effects (and with enormous support from the physicians working in IHS).  Note that in the years subsequent, there has been no nimiety of psychiatric physicians seeking to work or even volunteer in those pueblos of the Albuquerque area!

            “From those turbulent beginnings, and due both to vision and persistence, psychologists have been given authority to exercise prescriptive privileges in Iowa, Illinois, New Mexico, and Louisiana, as well as in the Public Health Service, the U.S. military, and Guam.  A cursory look at the New Mexico Board of Psychologist Examiners website reveals 40 names of persons with active certification as prescribing psychologists.  Though by no means thorough, an internet search turns up approximately 11 who are in PHS/IHS, state or federal agencies, or mental health facilities.  Many psychologists having national prominence in this area have now completed careers in federal services in the almost 30 years since those days in PHS/IHS.  We have indeed ‘come a long way!’

            “Yet there is much to be done.  For example, in Texas alone, 185 of the 254 counties have no psychiatrist.  Nurse Practitioners have been quite successful in extending their scope of practice to include prescriptive privileges – in many venues.  In fact, the future of primary care may well transfer to nurse practitioners, with the increasing specialization of medicine and the decreased number of young persons seeking careers in primary medicine, where reimbursement rates are far less than in high technology.  Yet, in Texas, and in many other states, the likelihood of expanding the scope of practice for psychology is not great.  I argue that is far more likely to occur when the basis is need (rather than greed).  Wouldn’t it be interesting if there were many programs to train psychologists to prescribe – at no cost to the person – in return for a two-year commitment to work in an underserved area?  Wouldn’t it be exciting if there were a national recognition of the absolute necessity to increase the array of health resources in now underserved areas – of which psychology could be a part?  At 75, I expect that I shall not live to see it, but I can dream, can’t I? (Floyd Jennings).”  Ray Folen, Executive Director of the Hawaii Psychological Association: “Over the last 10 years while at Tripler Army Medical Center I had written 3,178 prescriptions and my colleague Mike Kellar had written 5,780.  No adverse events.”  Psychology prides itself on being one of the learned professions.  Yet, whenever Beth Rom-Rymer provides an update on the exciting implementation of her Illinois success, one of our largest Divisions declines to publish her comments on their e-mail list serve; notwithstanding that RxP is APA policy.  “Our progeny have stars in their eyes.  Let’s help them realize their dreams (Beth).”  Perhaps this Division hopes to protect their membership from the future?  “You don’t know what I’ve done.”  Aloha,

Pat DeLeon, former APA President – Division 29 – August, 2016

 

ALOHA - Division 42 July column

“RECOGNIZE BARRIERS AND SHATTER THEM”

            The Extraordinary Vision of Give an Hour:  This Summer several USUHS nursing colleagues and I had the opportunity to attend a special Give an Hour symposium titled Veteran Wellbeing: Bridging the Divide, held at The National Press Club in Washington, DC.  Among the presenters were Dr. David Shulkin, VA Under Secretary for Health; Brian Duffy, Senior Vice Commander-In-Chief of the Veterans of Foreign Wars; Andrea Inserra, VP at Booz Allen Hamilton; and Kana Enomoto, Principal Deputy Administrator of SAMHSA.  Earlier that day the VA released its comprehensive analysis of Veteran suicide rates, examining over 55 million records, which sadly concluded that in 2014 the number of Veteran deaths by suicide averaged 20 per day.  Since 2001, the nation’s adult civilian suicide rate increased 23%, while Veteran suicides increased 32% during the same time period.  After controlling for age and gender, the risk of suicide for Veterans was 21% higher than for non-Veterans.  One positive note -- since 2001, the rate for those who used VA services increased by only 8.8% in contrast to a 38.6% increase for those who did not access VA services.  And yet, APA reports that only 40% of Veterans who screen positive for serious emotional problems seek help from a mental health professional and that female Veterans are particularly likely to suffer from mental health issues.

            Those presenting that morning discussed the critical importance of creating effective partnerships – with the VA, with the Veterans’ communities, and with the private sector.  They called for developing awareness and appreciation for Veterans representing Strategic Assets to their local communities.  The Under Secretary was extremely supportive of integrating behavioral health within primary care, establishing a Center for Compassionate Innovation; and increasing the availability of Complementary Medicine, including the use of Service Dogs.  Having attended several Give an Hour events, one could sense a changing culture – a growing willingness to openly address the “hidden wounds” of our nation’s longest armed conflict and thereby rejecting the stigma that has surrounded receiving mental health care.  Most importantly, one could sense a growing understanding that in order to address the mental health needs of those who serve, we must address the barriers that prevent all Americans from seeking and receiving proper care.

            Under Barbara Van Dahlen’s passionate leadership, Give an Hour has already facilitated over 192,000 hours of free mental health care donated by clinicians of all disciplines to our nation’s military, Veterans, and their families.  She is slowly developing enthusiasm within our State Psychological Associations with impressive success in New Hampshire and Wisconsin specifically around the Campaign to Change Direction, the national initiative that Give an Hour launched in 2015 focusing on changing the culture of mental health in America.  Recently, several mayors have expressed their interest in working with her on this important cultural agenda.  Most impressively, The First Lady and President Obama have personally been outstanding champions of all Americans learning the key components of Change Direction, the Five Signs of emotional suffering -- Change in Personality; Agitation; Withdrawal; Lack of Personal Care; and, Hopelessness.  Just like we all know the signs of a heart attack, all Americans – civilians, service members, and Veterans – can learn the signs of emotional suffering.  The critical question: Is YOUR State Psychological Association Involved?

Evolving Competition Targeting Consumer Demands:  During our tenure on the APA Board of Directors, Bruce Overmier and I would rhetorically wonder: “Why was APA in the accreditation business?”  The answer, of course, was to ensure quality education.  After rotating off the Board, I heard from various professional schools that the accreditation standards were considerably more restrictive than appropriate, especially given their underlying community-service mission.  I also heard that it was very difficult to incorporate health policy and relevant field experiences into the curriculum, notwithstanding how important this body of knowledge might be to the future of the profession.  Undoubtedly all involved have the best of intentions.

One of those professional schools recently reported that the new Standards of Accreditation, which will go into effect in January, 2017, are friendlier and more manageable for programs such as theirs which facilitates a health center/integrated care internship.  It will be interesting to see the impact of the expectation that all programs will send 50% of their interns to APA accredited internships.  Nevertheless, I remained somewhat uncomfortable that there has not been any viable alternative to the APA standards which clearly do impact state licensure and employment requirements.  Perhaps it is my legal background that suggests that competition per se is an important value that has served the nation admirably over the years and has often fostered unexpected beneficial changes in the status quo.  For example, the battles which psychology and nursing face in expanding their “scope of practice” are really all about competition -- although they are frequently fought under the guise of “ensuring quality care.”

Alan Kraut, a longtime friend and colleague, is now the Executive Director of the Psychological Clinical Science Accreditation System (PCSAS) which recognized its first program in 2009 and today accredits 30 clinical training programs in the U.S. and Canada.  PCSAS has been recognized by the Council of Higher Education Accreditation and VA recognition has now been approved.  Alan has always possessed a broader vision and consistently has stressed the importance of applying clinical science in ways that are highly effective in improving public health.  Few appreciate that when he was working for APA, he was instrumental in hosting professional psychology’s initial Black Tie fundraising dinner at our annual convention in Los Angeles.  The recipient that year was U.S. Senator Daniel K. Inouye.  Alan reports that even in the few days since the VA has recognized PCSAS, he has received a number of new inquiries from clinical programs around the nation asking about their new accreditation process.  He is now in discussions with DoD and the USPHS and, as should be expected, efforts are also underway to modify state psychology licensing laws and implementing regulations.  A viable alternative to APA accreditation seems to be finally emerging; one which Bruce suggests could well be viewed as “supplementary” rather than “competitive.”

Former VA senior psychologist Bob Zeiss shared with us the VA’s revised Qualification Standards governing psychology hiring.  The VA is the largest employer of psychologists and nurses and their new standards recognize PCSAS and Canadian Psychological Association accreditation.  In addition, ABPP status can now be used in lieu of an accredited internship, offering a viable workaround for those who failed to recognize the importance of an APA accredited internship while in graduate school.  The basic requirements for employment as a VA psychologist are prescribed by P.L. 96-151 [at the request of the late-U.S. Senator Daniel K. Inouye].  These include a doctoral degree in psychology from an accredited graduate program in psychology with a specialty area consistent with the assignment for which the applicant is applying.  Or, having a doctoral degree in any area of psychology and, in addition, successfully completing a respecialization program including an approved internship, accredited by APA or CPA.  For those who might have completed an internship that was not accredited at the time, board certification by ABPP will satisfy this requirement.  Under Bob’s leadership – and continuing under that of his successor Kenneth Jones (Director of Associated Health Education) -- the annual number of psychology post-doctoral training positions increased from 52 to 440, with the expectation that these numbers will increase further as a result of the Mental Health Expansion Initiative during the 2017-2018 academic year.  Currently in the public rulemaking process, already generating over 69,000 comments, VA is proposing to “increase veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians.”  In many ways, the VA is on the cutting-edge of our nation’s 21^st century health transformation.

The Implementation Process (RxP):  “Perhaps the most gratifying part of implementing our Illinois law is seeing and hearing the excitement of our undergraduate and graduate students as they envision themselves as full spectrum healthcare providers: prescribing psychologists.  Their eyes shine with delight at being the pioneers of their generation, creating paths of learning and practice for others to follow.  Our young students understand the frustrations of patients who need to wait for months to see a psychiatrist or who have no options but to consult primary care physicians who often don’t accurately identify the psychological disorders and are reluctant to prescribe psychotropic medications.  Our next generation of psychologists readily see themselves as healthcare leaders who will easily integrate medical as well as psychological and behavioral health information about their patients and will be able to create new and more effective healthcare modalities for clinic, hospital, community mental health, prison, nursing home, and medical settings.  While senior psychologists continue to debate the ‘pros and cons’ of RxP, our progeny immediately grasp the potential and are immersing themselves in their preparations to take their place in the vanguard of the modern healthcare environment” (Beth Rom-Rymer).  [The Good Girl’s Guide to Policy Advising – Tracey Koehlmoos].  Aloha,

Pat DeLeon, former APA President – Division 42 – July, 2016

 

RECOGNIZE BARRIERS AND SHATTER THEM

The Extraordinary Vision of Give an Hour:  This Summer several USUHS nursing colleagues and I had the opportunity to attend a special Give an Hour symposium titled Veteran Wellbeing: Bridging the Divide, held at The National Press Club in Washington, DC.  Among the presenters were Dr. David Shulkin, VA Under Secretary for Health; Brian Duffy, Senior Vice Commander-In-Chief of the Veterans of Foreign Wars; Andrea Inserra, VP at Booz Allen Hamilton; and Kana Enomoto, Principal Deputy Administrator of SAMHSA.  Earlier that day the VA released its comprehensive analysis of Veteran suicide rates, examining over 55 million records, which sadly concluded that in 2014 the number of Veteran deaths by suicide averaged 20 per day.  Since 2001, the nation's adult civilian suicide rate increased 23%, while Veteran suicides increased 32% during the same time period.  After controlling for age and gender, the risk of suicide for Veterans was 21% higher than for non-Veterans.  One positive note -- since 2001, the rate for those who used VA services increased by only 8.8% in contrast to a 38.6% increase for those who did not access VA services.  And yet, APA reports that only 40% of Veterans who screen positive for serious emotional problems seek help from a mental health professional and that female Veterans are particularly likely to suffer from mental health issues.

            Those presenting that morning discussed the critical importance of creating effective partnerships – with the VA, with the Veterans' communities, and with the private sector.  They called for developing awareness and appreciation for Veterans representing Strategic Assets to their local communities.  The Under Secretary was extremely supportive of integrating behavioral health within primary care, establishing a Center for Compassionate Innovation; and increasing the availability of Complementary Medicine, including the use of Service Dogs.  Having attended several Give an Hour events, one could sense a changing culture – a growing willingness to openly address the "hidden wounds" of our nation's longest armed conflict and thereby rejecting the stigma that has surrounded receiving mental health care.  Most importantly, one could sense a growing understanding that in order to address the mental health needs of those who serve, we must address the barriers that prevent all Americans from seeking and receiving proper care.

            Under Barbara Van Dahlen's passionate leadership, Give an Hour has already facilitated over 192,000 hours of free mental health care donated by clinicians of all disciplines to our nation's military, Veterans, and their families.  She is slowly developing enthusiasm within our State Psychological Associations with impressive success in New Hampshire and Wisconsin specifically around the Campaign to Change Direction, the national initiative that Give an Hour launched in 2015 focusing on changing the culture of mental health in America.  Recently, several mayors have expressed their interest in working with her on this important cultural agenda.  Most impressively, The First Lady and President Obama have personally been outstanding champions of all Americans learning the key components of Change Direction, the Five Signs of emotional suffering -- Change in Personality; Agitation; Withdrawal; Lack of Personal Care; and, Hopelessness.  Just like we all know the signs of a heart attack, all Americans – civilians, service members, and Veterans – can learn the signs of emotional suffering.  The critical question: Is YOUR State Psychological Association Involved?

Evolving Competition Targeting Consumer Demands:  During our tenure on the APA Board of Directors, Bruce Overmier and I would rhetorically wonder: "Why was APA in the accreditation business?"  The answer, of course, was to ensure quality education.  After rotating off the Board, I heard from various professional schools that the accreditation standards were considerably more restrictive than appropriate, especially given their underlying community-service mission.  I also heard that it was very difficult to incorporate health policy and relevant field experiences into the curriculum, notwithstanding how important this body of knowledge might be to the future of the profession.  Undoubtedly all involved have the best of intentions.

One of those professional schools recently reported that the new Standards of Accreditation, which will go into effect in January, 2017, are friendlier and more manageable for programs such as theirs which facilitates a health center/integrated care internship.  It will be interesting to see the impact of the expectation that all programs will send 50% of their interns to APA accredited internships.  Nevertheless, I remained somewhat uncomfortable that there has not been any viable alternative to the APA standards which clearly do impact state licensure and employment requirements.  Perhaps it is my legal background that suggests that competition per se is an important value that has served the nation admirably over the years and has often fostered unexpected beneficial changes in the status quo.  For example, the battles which psychology and nursing face in expanding their "scope of practice" are really all about competition -- although they are frequently fought under the guise of "ensuring quality care."

Alan Kraut, a longtime friend and colleague, is now the Executive Director of the Psychological Clinical Science Accreditation System (PCSAS) which recognized its first program in 2009 and today accredits 30 clinical training programs in the U.S. and Canada.  PCSAS has been recognized by the Council of Higher Education Accreditation and VA recognition has now been approved.  Alan has always possessed a broader vision and consistently has stressed the importance of applying clinical science in ways that are highly effective in improving public health.  Few appreciate that when he was working for APA, he was instrumental in hosting professional psychology's initial Black Tie fundraising dinner at our annual convention in Los Angeles.  The recipient that year was U.S. Senator Daniel K. Inouye.  Alan reports that even in the few days since the VA has recognized PCSAS, he has received a number of new inquiries from clinical programs around the nation asking about their new accreditation process.  He is now in discussions with DoD and the USPHS and, as should be expected, efforts are also underway to modify state psychology licensing laws and implementing regulations.  A viable alternative to APA accreditation seems to be finally emerging; one which Bruce suggests could well be viewed as "supplementary" rather than "competitive."

Former VA senior psychologist Bob Zeiss shared with us the VA's revised Qualification Standards governing psychology hiring.  The VA is the largest employer of psychologists and nurses and their new standards recognize PCSAS and Canadian Psychological Association accreditation.  In addition, ABPP status can now be used in lieu of an accredited internship, offering a viable workaround for those who failed to recognize the importance of an APA accredited internship while in graduate school.  The basic requirements for employment as a VA psychologist are prescribed by P.L. 96-151 [at the request of the late-U.S. Senator Daniel K. Inouye].  These include a doctoral degree in psychology from an accredited graduate program in psychology with a specialty area consistent with the assignment for which the applicant is applying.  Or, having a doctoral degree in any area of psychology and, in addition, successfully completing a respecialization program including an approved internship, accredited by APA or CPA.  For those who might have completed an internship that was not accredited at the time, board certification by ABPP will satisfy this requirement.  Under Bob's leadership – and continuing under that of his successor Kenneth Jones (Director of Associated Health Education) -- the annual number of psychology post-doctoral training positions increased from 52 to 440, with the expectation that these numbers will increase further as a result of the Mental Health Expansion Initiative during the 2017-2018 academic year.  Currently in the public rulemaking process, already generating over 69,000 comments, VA is proposing to "increase veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians."  In many ways, the VA is on the cutting-edge of our nation's 21^stcentury health transformation.

The Implementation Process (RxP):  "Perhaps the most gratifying part of implementing our Illinois law is seeing and hearing the excitement of our undergraduate and graduate students as they envision themselves as full spectrum healthcare providers: prescribing psychologists.  Their eyes shine with delight at being the pioneers of their generation, creating paths of learning and practice for others to follow.  Our young students understand the frustrations of patients who need to wait for months to see a psychiatrist or who have no options but to consult primary care physicians who often don't accurately identify the psychological disorders and are reluctant to prescribe psychotropic medications.  Our next generation of psychologists readily see themselves as healthcare leaders who will easily integrate medical as well as psychological and behavioral health information about their patients and will be able to create new and more effective healthcare modalities for clinic, hospital, community mental health, prison, nursing home, and medical settings.  While senior psychologists continue to debate the 'pros and cons' of RxP, our progeny immediately grasp the potential and are immersing themselves in their preparations to take their place in the vanguard of the modern healthcare environment" (Beth Rom-Rymer).  [The Good Girl's Guide to Policy Advising – Tracey Koehlmoos].  Aloha,

Pat DeLeon, former APA President – Division 42 – July, 2016

 

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ALOHA

INTERDISCIPLINARY COLLABORATION – GROWING ENTHUSIASM

One of the major foundations, and thus challenges, of President Obama’s landmark Patient Protection and Affordable Care Act (ACA) is moving our nation’s health care delivery system towards embracing interdisciplinary (i.e., interprofessional) collaboration and training.  In addressing our health policy class at the Uniformed Services University of the Health Science (USUHS) Polly Bednash, former CEO of the American Association of Colleges of Nursing (AACN), described the heartfelt personal commitment of the leadership of six major health professions organizations to radically impact the training experiences of their next generation of colleagues.  In 2009, they formed the Interprofessional Education Collaborative (IPEC) with the collaborative partners being the AACN, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy (AACP), the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools and Programs of Public Health.  APA joined IPEC in 2015 when its membership was expanded to include other educational/practice organizations committed to the education of clinicians for team-based care.  Recent actions by the APA Council of Representatives have been highly supportive of this effort.  Cynthia Belar, APA Interim CEO, has been actively involved throughout the process.

            Deborah Trautman, the new AACN President and CEO, announced the first annual Health Professions Week (HPW) initiative scheduled for this fall.  This will be a week-long event for high school and college students interested in learning more about careers in the health professions.  Each event will provide students with interactive opportunities to explore health-related education programs and careers – not to mention an online treasure hunt, on-campus events, and a two-day virtual fair.  Students will learn about 18 health professions and have the opportunity to talk directly with current health care providers.  The co-chair of this event represents AACP.

            The National Academy of Medicine (NAM) (formally, the Institute of Medicine) recently conducted a day and a half workshop on accreditation, which is becoming a major issue for those interested in developing interprofessional clinical placements.  The representative from AACP John Ressler: “I was honored to attend a workshop presented by the Global Forum on Innovation in Health Professional Education held on April 21-22, at the National Academies of the Sciences. Engineering and Medicine in Washington, DC.  The event was titled The Role of Accreditation in Enhancing Quality and Innovation in Health Professions Education.  The purpose of the workshop was to survey ideas from attendees on the impact and role of the accreditation process to enhance the quality of health professional education.

“Attendees represented a broad spectrum of organizations who share interests in positive patient outcomes and provided input on the role, if any, of accreditors to ensure students are adequately capable of providing this care.  The Forum provided a number of speakers representing various perspectives and the audience was asked to provide feedback and answers to related questions.  Attendees were asked to vote at the end of the workshop on whether accreditors should have input in this process.  The result was overwhelmingly positive as attendees believed it is of upmost concern that health professional education, accreditors and the health professions share a ‘social responsibility’ to provide quality health care to society.”

Lucinda Maine, EVP & CEO of AACP, estimates that 40-50 health disciplines were represented at the NAM meeting.  Lucinda is one of our regular USUHS policy speakers and has dramatically crystalized the unprecedented changes occurring within the health care environment with her discussions of the American Pharmaceutical Association Code of Ethics.  From 1922-1969: “Pharmacists should never discuss the therapeutic effect of a physician’s prescription with a patron or disclose details of composition which the physician has withheld.”  However, as of 1994: “A Pharmacist respects the covenantal relationship between the patient and pharmacist.  Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society.  In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.”  The current Pharmacy Code of Ethics clearly envisions treating the patient as a co-equal partner in his/her own health care decision making (another far-reaching element of the ACA).  On several occasions during class, Lucinda has raised the issue with our next generation: “Why do you call RxP ‘seeking prescriptive authority’?  Why not conceptualize obtaining this important clinical responsibility as ‘collaborative practice,’ as we do in pharmacy?”  In all but two states clinical pharmacists have obtained the clinical authority (under differing conditions similar to nursing) to modify and/or initiate medications.  Her suggestion could significantly change the underlying discussions at the State legislative level.

This spring Lucinda attended APA President Susan McDaniel’s Integrated Primary Care Alliance Presidential initiative held in the Tower Conference Room at APA.  Susan hosted a CEO and a leader in the Presidential cycle of 23 different health and mental health professional organizations that compose the integrated primary care team.  This list resulted in over 80 participants (pediatricians, internists, family physicians, nurse practitioners, physician assistants, psychiatrists, social workers, clinical pharmacists, etc.).  The objective for the weekend was to develop inter-organizational goals to move the needle forward on integrated primary care, which, by definition, will be interprofessional in nature.

A longtime friend and colleague, Alan Kraut, will soon become the Executive Director of the Psychological Clinical Science Accreditation System (PCSAS) which began in 2009 and currently is the accrediting agency for 30 psychology clinical training programs in the U.S. and Canada.  PCSAS has been recognized by the Council of Higher Education Accreditation (CHEA) and final regulations for VA recognition are pending.  When he was working for APA, Alan was instrumental in hosting professional psychology’s initial Black Tie fundraising dinner at our annual convention in Los Angeles.  The recipient that year was U.S. Senator Daniel K. Inouye.  Alan has always stressed the importance of applying clinical science in ways that are most effective in improving public health.

            A Different Perspective:  As Lucinda has suggested, how one conceptualizes an issue can radically shape the ensuing public debate.  Those opposed to the expansion of non-physician scope of practices frequently employ an emotional “public health hazard” argument; i.e., they would affirmatively harm their patients unless they were under the supervision of a physician.  With the steadily increasing number of colleagues having obtained advanced training in psychopharmacology and successfully passing the APA PEP exam, perhaps the time has arrived for shaping the discussion to be around access and inappropriate constraint of trade.  The Obama Administration has begun exploring this approach from several vantage points, including that of the Federal Trade Commission (FTC).

During their consideration of the Fiscal Year 2017 Appropriations bill for the Departments of Labor, Health and Human Services, and Education, the U.S. Senate Appropriations Committee expanded an initiative started in 2016 to reduce barriers created by a lack of interstate reciprocity for occupational licenses.  Additional funding was provided for consortia of States, with technical and other types of assistance from the Department of Labor, to evaluate and pursue cooperative approaches to enhance reciprocity or portability of occupational license across State lines.  Such agreements would significantly ease barriers to opportunity and reemployment for thousands of Americans, especially for military spouses, dislocated workers from various industries, and transitioning service members.  The Committee encouraged the Department to urge participating States to consider ways to increase their recognition of military certifications for equivalent private sector skills and occupations to further ease the transition of former service members to comparable civilian jobs.  An earlier White House report made clear that this exploration should include non-physician health care scope of practice issues.  Interestingly, the Administration has also reported that over the past two years 30% of new hires by the nation’s Federally Qualified Community Health Centers (CHCs) have been veterans.  For those with specialized training in RxP, and especially for those who have worked with the military, the future could be quite exciting.

Making a Difference, Step by Step:  Barbara Van Dahlen, President and CEO of Give an Hour, reports that they have already facilitated over 192,000 hours of free mental health care, donated by clinicians of all disciplines, to our nation’s military, veterans, and their families.  A key question for psychology: Has the leadership of your State Psychological Association joined the Campaign to Change Direction?  Have you personally considered Giving an Hour?  Ray Folen, the new Executive Director for the Hawaii Psychological Association: “Over the last 10 years, while at Tripler Army Medical Center I had written 3,178 prescriptions and my colleague Mike Kellar had written 5,780.  No adverse events.”  And, President Neal Morris took seriously the challenge of actively involving our next generation in the Division’s governance by appointing USUHS graduate students Joanna Sells and Omni Cassidy as convention program co-chairs.  “Serving as Division 55’s program co-chairs for the annual convention in Denver has been a very rewarding experience.  As graduate students, we can feel out of place when contacting established psychologists.  However, engaging colleagues as program co-chairs provided a meaningful context and purpose to developing relationships.  Now we both have a greater appreciation of how valuable it is to have others respond with an enthusiastic ‘Yes,’ when asked to contribute as a discussant, presenter, or organizer.  Shaping the development of a theme over time through collaboration and, in the Division’s case, interdisciplinary programming, is a great way to support the growth of psychology.  As the planning winds down, we realize how many volunteer hours go into executing programming for each of the 54 divisions and Candy’s fantastic support.  Discovering that this process happens each and every year is astounding!”  Aloha,

Pat DeLeon, former APA President – Division 55 – June, 2016

 

 

ALOHA

IT’S NOT WHO YOU KNOW -- IT’S WHO KNOWS YOU

            The Importance of Addressing National Needs:  The GAO recently released its report Additional Actions Needed to Enhance DoD’s Efforts to Address Mental Health Care Stigma, concluding that military service members perceive that a stigma exists with seeking mental health care.  Thirty-seven percent of active duty personnel and 39% of reservists responded that they thought seeking mental health care through the military would probably or definitely damage a person’s career.  HRSA lists mental health disorders as ranking in the top five chronic illnesses in the nation, with an estimated 25% of adults suffering currently while nearly half will during their lifetime.  Concerned about the perceived shortage of military mental health professionals, the U.S. Senate has proposed that DoD establish a pilot program utilizing physician assistants (PAs) to provide mental health care, specifically recommending the establishment of a PA psychiatric fellowship program of two years in length.

            In May of this year, Barbara Van Dahlen, President and CEO of Give an Hour, addressed the citizens of New Hampshire in their State House, along with the Governor, Senator Shaheen, and the State’s two Congresspersons.  Those present included members of the faith-based community, representatives from social service agencies, business leaders, educators, and caring citizens.  The Granite State was about to begin the first statewide launch of the Campaign to Change Direction, Barbara’s strategic effort designed to change the culture of mental health in America.  The initial phase focuses upon creating a common language by educating all Americans about the five key signs of emotional suffering.

A few weeks earlier, First Lady Michelle Obama joined with President George W. Bush and Prince Harry at the opening ceremonies of the 2016 INVICTUS Games in Orlando, Florida during which Wounded Service Members from 14 nations competed over four days in track and field, swimming, basketball, and other Olympic-type sports.  Prior to the opening ceremonies, the Invisible Injuries of War (e.g., PTSD) were highlighted at a special summit hosted by the Bush Institute and attended by high level officials and dignitaries from participant countries.  Prince Harry – who has talked openly about his own experience of flashbacks due to his deployments to Afghanistan – spoke at the event as did VA Secretary Bob McDonald.  Barbara addressed the need for culture change and premiered the new PSA for Change Direction.  This powerful video features Prince Henry speaking about the need to be more open and honest about mental health.  APA’s Randy Phelps and Heather O’Beirne Kelly were present.

The First Lady and President Obama have personally been outstanding champions of all Americans learning the Five Signs which are: Change in Personality; Agitation; Withdrawal; Lack of Personal Care; and, Hopelessness.  Give an Hour, which has been enthusiastically supported by numerous celebrities, including my favorite Brian Wilson of the Beach Boys, has already facilitated over 192,000 hours of free mental health care donated by clinicians of all disciplines to our nation’s military, veterans, and their families.  A key question for psychology: Has the leadership of your State Psychological Association joined the Campaign to Change Direction?  Have you encouraged your members to Give an Hour?

            Competition Is Always Beneficial:  A longtime colleague, Alan Kraut, will soon become the Executive Director of the Psychological Clinical Science Accreditation System (PCSAS) which began in 2009 and currently is the accrediting agency for 30 clinical training programs in the U.S. and Canada.  PCSAS has been recognized by the Council of Higher Education Accreditation (CHEA) and final regulations for VA recognition are pending.  Alan has always stressed the importance of applying clinical science in ways that are most effective in improving public health.  Aloha,

Pat DeLeon, former APA President -- Division 31 – June, 2016

 

IT’S NOT WHO YOU KNOW -- IT’S WHO KNOWS YOU

The Importance of Addressing National Needs:  The GAO recently released its report Additional Actions Needed to Enhance DoD's Efforts to Address Mental Health Care Stigma, concluding that military service members perceive that a stigma exists with seeking mental health care.  Thirty-seven percent of active duty personnel and 39% of reservists responded that they thought seeking mental health care through the military would probably or definitely damage a person's career.  HRSA lists mental health disorders as ranking in the top five chronic illnesses in the nation, with an estimated 25% of adults suffering currently while nearly half will during their lifetime.  Concerned about the perceived shortage of military mental health professionals, the U.S. Senate has proposed that DoD establish a pilot program utilizing physician assistants (PAs) to provide mental health care, specifically recommending the establishment of a PA psychiatric fellowship program of two years in length.

            In May of this year, Barbara Van Dahlen, President and CEO of Give an Hour, addressed the citizens of New Hampshire in their State House, along with the Governor, Senator Shaheen, and the State's two Congresspersons.  Those present included members of the faith-based community, representatives from social service agencies, business leaders, educators, and caring citizens.  The Granite State was about to begin the first statewide launch of the Campaign to Change Direction, Barbara's strategic effort designed to change the culture of mental health in America.  The initial phase focuses upon creating a common language by educating all Americans about the five key signs of emotional suffering.

A few weeks earlier, First Lady Michelle Obama joined with President George W. Bush and Prince Harry at the opening ceremonies of the 2016 INVICTUS Games in Orlando, Florida during which Wounded Service Members from 14 nations competed over four days in track and field, swimming, basketball, and other Olympic-type sports.  Prior to the opening ceremonies, the Invisible Injuries of War (e.g., PTSD) were highlighted at a special summit hosted by the Bush Institute and attended by high level officials and dignitaries from participant countries.  Prince Harry – who has talked openly about his own experience of flashbacks due to his deployments to Afghanistan – spoke at the event as did VA Secretary Bob McDonald.  Barbara addressed the need for culture change and premiered the new PSA for Change Direction.  This powerful video features Prince Henry speaking about the need to be more open and honest about mental health.  APA's Randy Phelps and Heather O'Beirne Kelly were present.

The First Lady and President Obama have personally been outstanding champions of all Americans learning the Five Signs which are: Change in Personality; Agitation; Withdrawal; Lack of Personal Care; and, Hopelessness.  Give an Hour, which has been enthusiastically supported by numerous celebrities, including my favorite Brian Wilson of the Beach Boys, has already facilitated over 192,000 hours of free mental health care donated by clinicians of all disciplines to our nation's military, veterans, and their families.  A key question for psychology: Has the leadership of your State Psychological Association joined the Campaign to Change Direction?  Have you encouraged your members to Give an Hour?

            Competition Is Always Beneficial:  A longtime colleague, Alan Kraut, will soon become the Executive Director of the Psychological Clinical Science Accreditation System (PCSAS) which began in 2009 and currently is the accrediting agency for 30 clinical training programs in the U.S. and Canada.  PCSAS has been recognized by the Council of Higher Education Accreditation (CHEA) and final regulations for VA recognition are pending.  Alan has always stressed the importance of applying clinical science in ways that are most effective in improving public health.  Aloha,

Pat DeLeon, former APA President -- Division 31 – June, 2016

 

Sent from my iPhone