This has been a fascinating spring. To celebrate our 50th anniversary, my wife and I decided to visit New Zealand. We arrived slightly after the Christchurch tragedy and were extraordinarily impressed by how the entire nation responded. There were vigils of silence, including one on our ferry out to see the incredible glow worms. The Prime Minister's call for a ban on almost all semiautomatic weapons was overwhelmingly supported by the politicians and electorate. Unlike the public discourse in the United States, there were thoughtful discussions regarding the adverse impact of global warming, the increasing pollution of the oceans, and the critical importance of the environment. Simply stated, New Zealand and their concerned citizenry were absolutely refreshing.
Just prior to departing for New Zealand, I once again had the opportunity to attend the annual APA Practice Leadership conference Advocacy and Leadership, which is always the highlight of my psychology year. Dan Abrahamson estimated that 400 of our colleagues from across the nation participated. Jared Skillings' visionary Welcoming Remarks: "These are exciting – and challenging – times for APA and for our discipline; there are a lot of changes going on… and it's up to us – all of us – to make the most of the opportunities that are here now. At APA, we're committed to moving the profession in a proactive way toward the things that will make us most successful as practitioners. That means looking forward and thinking creatively about how we can have a positive impact in the world. Transformational change. I don't just mean change within the practice community. The world around us has changed – society, the business marketplace, health care, technology. They're all going to keep changing. We must respond. We must figure out not only how to adapt but thrive. The leadership roles you hold are crucial in this regard. Our diversity is one of our greatest strengths. And from where I stand, the future of our profession – the future of the this association – looks very promising, not in spite of the changes we face, but because of them. Change is inevitable. The impact we can have depends on you."
Given the intense national debates on immigration within the United States, one of the most personally moving presentations was the workshop on "Building Bridges and Tearing Down Walls: A Model for Empirically-Based State and Legislative Advocacy on Immigration," highlighting psychologists making a difference in the lives of real people. Lest we forget the past, Shirley Ann Higuchi discussed the way our nation shamefully treated Japanese-American citizens during World War II; incarcerating many in 10 camps from California to Arkansas, including at wintery Heart Mountain in Wyoming where her parents were incarcerated.
Yale University Associate Professor Manuel Paris: "Our report, Vulnerable But Not Broken: Psychosocial Challenges and Resilience Pathways among Unaccompanied Children from Central America, provides an overview of the myriad issues facing unaccompanied children from Central America apprehended at the Southwest border of the United States. It highlights these children's ability to overcome challenging histories and adapt to the changes in familial and social environment that life in the United States presents, and identifies some of the key supportive resources that can help them to do so. The psychosocial aspects of this humanitarian crisis are reviewed, outlining priority areas for future research and providing recommendations for culturally and developmentally informed practice, programs, and legal advocacy.
"The overarching goal of the report is to shed light on the plight of unaccompanied children from a mental health perspective and to provide insights borne out of research and the clinical experiences of the authors. It is important to discuss and highlight the obstacles faced by this vulnerable population, but more importantly to focus on their resilience processes and what can be done to support them. This includes a 'call to action' effort – essentially providing pertinent information that can be used to assist in advocacy efforts. To champion the rights and needs of unaccompanied children effectively at the local, state and federal levels, legislators and other stakeholders need evidence-based information and scientific support for their positions. The report is structured so that specific sections can be utilized to provide targeted, strategic messaging depending on the advocacy needs and issues to be addressed. Ultimately, only with effective working alliances among advocates, researchers, legislators, clinicians, law enforcement, and attorneys can we find a viable approach to alleviate the suffering unaccompanied children experience at different points during their journey towards safety and stability and provide the resources to foster the healthy development to which they are entitled" (Giselle Hass, Georgetown University Adjunct Professor of Law; Cristina Muniz de la Pena, Cofounder & Mental Health Director of Terra Firma Healthcare and Justice for Immigrant Children, Michelle Silva; Charles Baily, Claudette Antuna, and Tejaswinhi Srinivas).
Former APA President, and also a Yale University faculty member and 2019 Gold Medal recipient, Alan Kazdin has constantly been urging our profession to appreciate the global importance of insuring that psychology's efforts are getting to the people in need (not only clinicians who only see a tiny fraction of those in need) and as part of that, people especially not likely to receive any care (e.g., children, older individuals, single parents, individuals of ethnicity, victims of violence, and it goes on). "I love academia (it is my life) but the hedging that is done when real people can be helped or harmed is (for me) inexcusable. What ought to be our criteria for deciding when we have enough to act when it is virtually always the case that we do not have complete answers? Many of the advances are coming from other disciplines, such as public health, law, social policy, business, and industry."
Dan Abrahamson and Susie Lazaroff (who makes the conference "work") have always been open to inviting students from the Uniformed Services University (USU) from both psychology and nursing to participate at the national level. One of the foundational concepts of President Obama's Patient Protection and Affordable Care Act (ACA) is the development of interprofessional team-based integrated care. What better way for these two professions to appreciate their common contributions than exposure at the graduate student level?
"We attended the APA Practice Leadership Conference which was focused on advocacy and leadership. It aimed to inspire psychology's leaders to join together with colleagues and advocate for change in health care policies related to billing, licensing regulations, and practice technologies. We were able to meet and network with psychologists around the country. On Sunday, David Wasserman used humor and statistics to provide an overview of the history and current state of the political environment, including how President Trump won the White House. He emphasized the importance of voting in primary elections as well as general elections at the state and national levels because legislative leaders at all levels impact state and federal law.
"During the breakout session titled 'Psychology of Issues Advocacy: Maximizing Your Impact with Lawmakers' we learned about advocacy at the local, state, and national levels. The talk began by talking about social justice versus diversity. Diversity showcases representation across races, while social justice is a collaborative approach to equity across all races. The presenter highlighted the need to identify – What is the issue that is going to be raised and how is it best raised? Aaron Bishop, Director of the APA Public Interest Government Relations Office, uses the 'Rule of Three' to engage with elected officials. First he emphasized the importance of relationship building through multiple visits to help you be remembered prior to making a request. It is helpful to first describe your issue, share information, and create a reason to maintain contact. Offering them something such as an article or data can help bring their attention to an issue without making a request. The second contact is a follow-up in 1-2 weeks with information about an issue. And the third contact is when to make a request. We broke out into small groups to talk about how to further engage with elected officials. Our group identified the need to understand the opposition that the elected officials face in order to be prepared to defend our positions. Other groups identified the need to create an army of experts, send thank-you notes because elected officials like them and don't receive them very often, and be a resource for the Members of Congress. We concluded the meeting by talking about the staffers. Staffers get the job done and getting to the Chief of Staff is key. Bring personal stories to pull them into the issue.
"At lunch many state psychological associations were recognized for their influence at the state level. Overall this event offered us the opportunity to learn about our role as healthcare advocates for our profession and patients. Many of the speakers emphasized the importance of integrated social aspects of care with practice issues. We were able to network with each other and people in the psychology field which helps us to better understand the issues surrounding their practice. We definitely noted similarities between the interactions that psychology has with psychiatry, when compared to nursing and medicine. The conference was a great opportunity for learning and relationship building" (Joseph Leondike, Tonya Spencer, and Theresa Bedford, Daniel K. Inouye Graduate School of Nursing, USU). Aloha, [New Zealand National Anthem – Maori language].
Pat DeLeon, former APA President – HPA – May, 2019
Sent from my iPhone
Monday, May 20, 2019
Sunday, May 19, 2019
ALOHA - HPA
“E IHOWA ATUA”
This has been a fascinating spring. To celebrate our 50th anniversary, my wife and I decided to visit New Zealand. We arrived slightly after the Christchurch tragedy and were extraordinarily impressed by how the entire nation responded. There were vigils of silence, including one on our ferry out to see the incredible glow worms. The Prime Minister’s call for a ban on almost all semiautomatic weapons was overwhelmingly supported by the politicians and electorate. Unlike the public discourse in the United States, there were thoughtful discussions regarding the adverse impact of global warming, the increasing pollution of the oceans, and the critical importance of the environment. Simply stated, New Zealand and their concerned citizenry were absolutely refreshing.
Just prior to departing for New Zealand, I once again had the opportunity to attend the annual APA Practice Leadership conference Advocacy and Leadership, which is always the highlight of my psychology year. Dan Abrahamson estimated that 400 of our colleagues from across the nation participated. Jared Skillings’ visionary Welcoming Remarks: “These are exciting – and challenging – times for APA and for our discipline; there are a lot of changes going on… and it’s up to us – all of us – to make the most of the opportunities that are here now. At APA, we’re committed to moving the profession in a proactive way toward the things that will make us most successful as practitioners. That means looking forward and thinking creatively about how we can have a positive impact in the world. Transformational change. I don’t just mean change within the practice community. The world around us has changed – society, the business marketplace, health care, technology. They’re all going to keep changing. We must respond. We must figure out not only how to adapt but thrive. The leadership roles you hold are crucial in this regard. Our diversity is one of our greatest strengths. And from where I stand, the future of our profession – the future of the this association – looks very promising, not in spite of the changes we face, but because of them. Change is inevitable. The impact we can have depends on you.”
Given the intense national debates on immigration within the United States, one of the most personally moving presentations was the workshop on “Building Bridges and Tearing Down Walls: A Model for Empirically-Based State and Legislative Advocacy on Immigration,” highlighting psychologists making a difference in the lives of real people. Lest we forget the past, Shirley Ann Higuchi discussed the way our nation shamefully treated Japanese-American citizens during World War II; incarcerating many in 10 camps from California to Arkansas, including at wintery Heart Mountain in Wyoming where her parents were incarcerated.
Yale University Associate Professor Manuel Paris: “Our report, Vulnerable But Not Broken: Psychosocial Challenges and Resilience Pathways among Unaccompanied Children from Central America, provides an overview of the myriad issues facing unaccompanied children from Central America apprehended at the Southwest border of the United States. It highlights these children’s ability to overcome challenging histories and adapt to the changes in familial and social environment that life in the United States presents, and identifies some of the key supportive resources that can help them to do so. The psychosocial aspects of this humanitarian crisis are reviewed, outlining priority areas for future research and providing recommendations for culturally and developmentally informed practice, programs, and legal advocacy.
“The overarching goal of the report is to shed light on the plight of unaccompanied children from a mental health perspective and to provide insights borne out of research and the clinical experiences of the authors. It is important to discuss and highlight the obstacles faced by this vulnerable population, but more importantly to focus on their resilience processes and what can be done to support them. This includes a ‘call to action’ effort – essentially providing pertinent information that can be used to assist in advocacy efforts. To champion the rights and needs of unaccompanied children effectively at the local, state and federal levels, legislators and other stakeholders need evidence-based information and scientific support for their positions. The report is structured so that specific sections can be utilized to provide targeted, strategic messaging depending on the advocacy needs and issues to be addressed. Ultimately, only with effective working alliances among advocates, researchers, legislators, clinicians, law enforcement, and attorneys can we find a viable approach to alleviate the suffering unaccompanied children experience at different points during their journey towards safety and stability and provide the resources to foster the healthy development to which they are entitled” (Giselle Hass, Georgetown University Adjunct Professor of Law; Cristina Muniz de la Pena, Cofounder & Mental Health Director of Terra Firma Healthcare and Justice for Immigrant Children, Michelle Silva; Charles Baily, Claudette Antuna, and Tejaswinhi Srinivas).
Former APA President, and also a Yale University faculty member and 2019 Gold Medal recipient, Alan Kazdin has constantly been urging our profession to appreciate the global importance of insuring that psychology’s efforts are getting to the people in need (not only clinicians who only see a tiny fraction of those in need) and as part of that, people especially not likely to receive any care (e.g., children, older individuals, single parents, individuals of ethnicity, victims of violence, and it goes on). “I love academia (it is my life) but the hedging that is done when real people can be helped or harmed is (for me) inexcusable. What ought to be our criteria for deciding when we have enough to act when it is virtually always the case that we do not have complete answers? Many of the advances are coming from other disciplines, such as public health, law, social policy, business, and industry.”
Dan Abrahamson and Susie Lazaroff (who makes the conference “work”) have always been open to inviting students from the Uniformed Services University (USU) from both psychology and nursing to participate at the national level. One of the foundational concepts of President Obama’s Patient Protection and Affordable Care Act (ACA) is the development of interprofessional team-based integrated care. What better way for these two professions to appreciate their common contributions than exposure at the graduate student level?
“We attended the APA Practice Leadership Conference which was focused on advocacy and leadership. It aimed to inspire psychology’s leaders to join together with colleagues and advocate for change in health care policies related to billing, licensing regulations, and practice technologies. We were able to meet and network with psychologists around the country. On Sunday, David Wasserman used humor and statistics to provide an overview of the history and current state of the political environment, including how President Trump won the White House. He emphasized the importance of voting in primary elections as well as general elections at the state and national levels because legislative leaders at all levels impact state and federal law.
“During the breakout session titled ‘Psychology of Issues Advocacy: Maximizing Your Impact with Lawmakers’ we learned about advocacy at the local, state, and national levels. The talk began by talking about social justice versus diversity. Diversity showcases representation across races, while social justice is a collaborative approach to equity across all races. The presenter highlighted the need to identify – What is the issue that is going to be raised and how is it best raised? Aaron Bishop, Director of the APA Public Interest Government Relations Office, uses the ‘Rule of Three’ to engage with elected officials. First he emphasized the importance of relationship building through multiple visits to help you be remembered prior to making a request. It is helpful to first describe your issue, share information, and create a reason to maintain contact. Offering them something such as an article or data can help bring their attention to an issue without making a request. The second contact is a follow-up in 1-2 weeks with information about an issue. And the third contact is when to make a request. We broke out into small groups to talk about how to further engage with elected officials. Our group identified the need to understand the opposition that the elected officials face in order to be prepared to defend our positions. Other groups identified the need to create an army of experts, send thank-you notes because elected officials like them and don’t receive them very often, and be a resource for the Members of Congress. We concluded the meeting by talking about the staffers. Staffers get the job done and getting to the Chief of Staff is key. Bring personal stories to pull them into the issue.
“At lunch many state psychological associations were recognized for their influence at the state level. Overall this event offered us the opportunity to learn about our role as healthcare advocates for our profession and patients. Many of the speakers emphasized the importance of integrated social aspects of care with practice issues. We were able to network with each other and people in the psychology field which helps us to better understand the issues surrounding their practice. We definitely noted similarities between the interactions that psychology has with psychiatry, when compared to nursing and medicine. The conference was a great opportunity for learning and relationship building” (Joseph Leondike, Tonya Spencer, and Theresa Bedford, Daniel K. Inouye Graduate School of Nursing, USU). Aloha, [New Zealand National Anthem – Maori language].
Pat DeLeon, former APA President – HPA – May, 2019
Thursday, May 9, 2019
LOOKING BACK -- MOTIVATION FOR MOVING FORWARD
In September, 1985 APA published A Women's Mental Health Agenda, under the editorship of Nancy Felipe Russo, following up on a conference to assess the status of women's mental health needs, identify priority areas, and create an interdisciplinary network to facilitate implementation of their recommendations. Participating in the conference were former APA Presidents Florence Denmark and Bonnie Strickland; as well as Angie McBride, a nurse-psychologist who served as Dean of the Indiana University School of Nursing and is one of nursing's Living Legends. Those interested in psychology's prescriptive (RxP) authority quest should seriously consider whether significant progress has really been made in our nation's mental health delivery system over the past three decades. Highlights of their visionary report:
Research, education and training, and prevention programs were seen as tools for change. Increasing the participation of women at all levels in the mental health delivery system – as providers and as policymakers – was seen as the first step. That participation was considered a necessary condition for eliminating sex bias and sex role stereotyping in the delivery of mental health services. Developing appropriate diagnosis, treatment, rehabilitation, and prevention strategies requires recognition of the impact of the social context on women's mental health, a position that challenges traditional intrapsychic, biomedical approaches to mental disorder. The call for strong interdisciplinary collaboration foretells today's emphasis on Interprofessional Education (IPE), a personal priority of former APA President Susan McDaniel, as well as reflecting her focus on integrated care.
Women were more likely than men to use mental health services, particularly outpatient services, but men were more likely to be seen by mental health professionals. Nearly one-half of women's mental health visits were made in the general medical sector, suggesting that primary physicians play a disproportionate role in the treatment of women's mental health problems as compared to men's. More than two-thirds of all prescriptions for psychotropic drugs were for women. Although women made up 58% of all visits to physicians' offices, they received 73% of all prescriptions written for psychotropic medications (and 90% when the prescribing physician was not a psychiatrist). Although twice as many women as men were treated for depression, the depression literature suggests that it is the men rather than the women who benefit most from the antidepressant drugs.
In June, 1998 the National Center on Addiction and Substance Abuse at Columbia University released their report Under The Rug: Substance Abuse and The Mature Woman. Relevant Highlights: The destructive relationship between depression and alcohol abuse is particularly strong among women. At any age, alcoholic females are twice as likely as non-alcoholic females to be depressed and almost four times likelier than male alcoholics to be depressed. Inappropriate prescribing is common and can contribute to abuse and addiction. One out of six Medicare beneficiaries (3.5 million mature women) receives at least one inappropriate prescription. For many psychologists, social justice, by ensuring that the highest quality of care will be provided, has always been the critical vision behind RxP.
Prescriptive Authority (RxP): "It was 19 years ago now that we first developed the Fairleigh Dickinson Clinical Psychopharmacology program to provide training in preparation for prescriptive authority completely online. In 2002 we converted it to a Master's program, making it the second distance program offering a degree after Alliant University, the same year New Mexico became the first state to pass RxP legislation. When Louisiana passed its legislation in 2004, we saw the dominoes starting to fall and thought the critical mass would come soon. We had no idea how long it would be till the third state (Illinois) would join the club in 2014, which we owe to the great work done by Beth Rom-Rymer. Despite the long dry spell, the program has enrolled a new class every year for almost 20 years. I finally stepped down as Director in 2015, with Anne Farrar-Anton carrying the torch since then, though I still provide backup in my role as the Director of the School of Psychology. The program continues to evolve: our latest challenge has to do with how we would deal with the unique medical rotations requirement in the Illinois law, and we're working on the solution right now. The recent addition of Iowa and Idaho to the club tells us that maybe the critical mass is finally here, and we look forward to continuing to help psychologists from all over the country prepare themselves for that day" (Bob McGrath).
Maturing Successes: Iowa -- "As part of the legislation for prescriptive authority for psychologists in Iowa, we needed to create the administrative rules jointly with the Board of Medicine (BOM). In September, 2016 members appointed by the BOM and members appointed by the Board of Psychology (BOP) met for the first time to determine rules each group could support to their larger boards respectively. From September, 2016 until April, 2018 this sub-committee met regularly. There was considerable discussion regarding the training required. The fact that the post-doctoral master's degree programs are not yet accredited was difficult for our medical folks to understand. Conversations with APA about the process of accreditation compared to designation were held and Cathi Grus was very helpful in creating a comparison hand-out for the BOM members to visualize the similarities in each process. Once consensus on the degree program was reached, the practicum and supervision years were discussed. While this did not present as much of a challenge, there were still some intense conversations about who could be a training physician, a supervising physician, and a collaborating physician. In the end, the sub-committees reached consensus in April, 2018 and the rules as proposed were sent to the full Boards. At the June, 2018 BOM meeting they voted to notice the proposed rules for public comment and the BOP did the same.
"The public hearing was held August 21, 2018. At the hearing, the same concerns and suggestions from the opposing medical groups were heard. These were the same suggestions for amendments heard during the legislative sessions. Over the course of the BOM meetings in September and October, a couple of amendments were made to be more clear about releases of information and which physician involved with the training of the psychologist was responsible for what activity. On December 14, 2018 the BOM voted to adopt the rules as amended and on December 21, 2018 the BOP voted the same. These adopted rules were then filed by December 26th for notice on January 16th, 2019. The notice period of 20 days was concluded February 5th and the Administrative Rules Review Committee (ARRC) of the legislature met on February 8, 2019. The week prior to this meeting, some members of the ARRC were approached by the lobbyist of the Iowa Psychiatric Society who was requesting a session delay on the rules. There was some quick action taken to summarize the events of the past 2.5 years for the committee and ultimately, the rules were adopted without fanfare on February 8th. This was a long and challenging process and would not have been accomplished without the help and support of many, many people" (Bethe Lonning).
Connecticut -- "RxP is rolling along in the cold and snowy State of Connecticut early in March, 2019! You might recall that last year we were granted a Request for Review of Scope of Practice by the CT Department of Public Health (DPH). After a series of meetings with DPH and health care organizations (e.g., MDs, APRNs, Hospital Association, etc.), we engaged in 'discussions' and DPH reported on it all to the legislature. Since then, we have continued to advocate. In early February we had a 'Speed-Dating for Advocating' meeting with the Co-Chairs, a Vice Chair, and a Ranking Member (a physician) of the Public Health Committee (PHC), all of whom were knowledgeable and open to conversation.
"Then, later in the month, we received great news! The PHC of the CT State Legislature agreed to sponsor a bill, SB 966 An Act Concerning The Prescriptive Authority of Psychologists. The Public Hearing has not yet been scheduled, but will be within the next few weeks. We are proud and excited that CT is willing to take this step. We've still got a long way to go, that's for sure. But for now, get the snow mobile going!" (Barbara Bunk, Co-Chair).
Florida -- "In Florida we now have multiple sponsors and cosponsors in the Florida House and Senate. Legislative Day will occur in a few weeks and our Florida Psychological Association (FPA) members will meet with their local legislators to drum up support. We continue to gather information and answer questions for our legislators. We are very encouraged by the progress we've made to date and the support we're receiving from our elected representatives who tend to see this as a 'freedom of choice' issue. The White House released a report at the end of 2018 entitled Reforming America's Healthcare System Through Choice and Competition authored by the Secretaries of the Departments of Health and Human Services, Treasury, and Labor. It states in part:
"'As health care spending continues to rise, Americans are not receiving the commensurate benefit of living longer, healthier lives. Health care bills are too complex, choices are too restrained, and the insurance premiums and out-of-pocket costs are climbing faster than wages and tax revenue. Health care markets could work more efficiently and Americans could receive more effective, high-value care if we remove and revise certain federal and state regulations and policies that inhibit choice and competition…. Reduced competition among clinicians leads to higher prices for health care services, reduces choice, and negatively impacts overall health care quality and the efficient allocation of resources. Government policies have suppressed competition by reducing the available supply of providers and restricting the range of services that they can offer. This report recommends policies that will broaden providers' scope of practice [SOP] while improving workforce mobility, including telehealth, to encourage innovation and to allow providers more easily to meet patients' needs…. States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set.' It seems to me that we psychologists are on the right side of history. The times they are, indeed, changing" (Steve Ragusea).
Illinois – "At the Illinois Sixth Biannual Prescriptive Authority Networking event on Saturday night, February 2nd, I had the great honor and privilege of being given recognition as an 'Outstanding Leader' from the CEO of AMITA Health, one of our most important partners in the implementation of our Prescriptive Authority legislation in Illinois. With over 92 people, that included 20 students, interested in pursuing training to become prescribing psychologists; four of the 10 graduate students who are pursuing the joint degree in Clinical Psychopharmacology and Clinical Psychology; 15 of the more than 50 licensed psychologists who are currently doing their didactic training to become prescribing psychologists; five of the 10 psychologists who are currently doing their medical rotations; and the psychologist who is just a few months away from receiving his prescribing license; it was an exciting, electric evening.
"To begin the evening's program, we had two inspiring and dynamic keynote speakers, who very well articulated the connection between the needs of the most vulnerable and underserved populations in our society and the burgeoning presence of prescribing psychologists: a great community partner, Mark Ishaug, President and CEO of Thresholds, the largest and oldest social service agency in Illinois, that works with the most seriously mentally ill population in our state; and a wonderful psychologist colleague, Morgan Sammons, retired Navy Captain, in the first cohort of military psychologists who were trained as prescribers in 1992, formerly Dean of CSPP, Alliant International University, and now Executive Officer of the National Register of Health Service Psychologists.
"Following our keynote speakers, the practicing psychologists spoke about their training in Clinical Psychopharmacology (CP); then, the graduate students talked about the incredibly broadening experience of their training in CP at the pre-doctoral level. Finally, the large group of 20 graduate students talked about their interest in studying CP and their reasons for wanting to become prescribing psychologists. What we most heard was that these young students wanted opportunities to work, more effectively, with communities who have been chronically underserved. Since this was our Sixth Prescriptive Authority Networking event. Illinois psychologists, interested in pursuing Prescriptive Authority, came to renew and create important collegial relationships. It's not unusual for our psychologists to find long lost friends and colleagues at our events!
"Our APA Convention will be in Chicago this summer! I am, therefore, scheduling our Prescriptive Authority Networking event for August 11th, the Sunday of Convention, and extending our welcome to include psychologist participants from all around the country! Our Prescriptive Authority Movement has partnered with powerful community healthcare systems, like AMITA Health, and associations that serve the most underserved populations in our State, including Thresholds and NAMI. On August 11th, our APA CEO, Arthur Evans, will speak, as will our APA President Rosie Phillips Davis. In addition, we will have our Illinois community partners; our state legislative champions; our prescribing psychologists; our young graduate student trainees and older, practicing prescribing psychology trainees speak. I am thrilled to demonstrate, to our larger community, how Illinois psychologists are training for the future!" (Beth Rom-Rymer).
Reflections: "Talk about memory lane. The WMHA conference was an outgrowth of the work of the Subpanel on the Mental Health of Women of President Carter's Commission on Mental Health. Being co-chair of that Subpanel with psychiatrist Elaine Carmen, I met and learned from the 'stars' of the women's health movement across the health professions and applied those lessons in my role as Head of the Women's Programs Office at APA and Chair of the National Coalition for Women's Mental Health.
"1. The 'facts' are only the beginning. After completing our work documenting the impact of women's roles and circumstances on their mental health, the word got back to us that the entrenched power structure of the NIMH basically patronized and dismissed social determinants of women's behavior; the biomedical model reigned. It was not to be borne. I obtained a conference grant from the Ittleson Foundation and we were off and running.
"2. Clear goals and the power to achieve them are essential for a conference to produce actual social change. With the Subpanel report, we didn't need yet another research conference. What we needed was to build an advocacy framework and unified message to get our allies in prevailing power structures (e.g., professional associations and women's advocacy groups) on board to push for specific changes. The formula to constructing a conference leading to actual change was having the right mix of leaders, a leadership structure for follow-up, and a bit of sleight of hand – and we pulled it off. The WMHA was crafted and the National Coalition for Women's Mental Health was born.
"3. The conference's inclusive selection process was a key component for long term success. Having diverse voices at the table when discussing women's roles and circumstances is essential for the perspective-taking needed to generate effective prevention and intervention strategies. In constructing the conference, we not only had a separate working group focusing on special populations, we had individuals (professionals and advocates) from such populations represented in all the groups. The cross fertilization of ideas across the disciplines and life experiences was energizing. We weren't agonizing, we were organizing! We were individuals who shared core values who recognized that women's roles and life contexts were not conducive to mental health -- of women or men" (Nancy).
"You brought me back in time. The mental health agenda we proposed has given birth to some positive changes – women included in earlier stages of drug testing to see if effective, violence against women taken more seriously, PTSD enlarged as a concept to include the rape experience and other traumas likely to affect women. But there remain topics that we raised that still affect women's mental health – the role of stress of combining work and family (much less combining leadership and family) without social supports, the stereotype that shapes whether we see women as authority figures, how clinicians respond to women's and men's same presenting symptoms differently. My best to my partners of 1985" (Angela). Aloha,
Pat DeLeon, former APA President – Division 55 – March, 2019
Sent from my iPhone
Research, education and training, and prevention programs were seen as tools for change. Increasing the participation of women at all levels in the mental health delivery system – as providers and as policymakers – was seen as the first step. That participation was considered a necessary condition for eliminating sex bias and sex role stereotyping in the delivery of mental health services. Developing appropriate diagnosis, treatment, rehabilitation, and prevention strategies requires recognition of the impact of the social context on women's mental health, a position that challenges traditional intrapsychic, biomedical approaches to mental disorder. The call for strong interdisciplinary collaboration foretells today's emphasis on Interprofessional Education (IPE), a personal priority of former APA President Susan McDaniel, as well as reflecting her focus on integrated care.
Women were more likely than men to use mental health services, particularly outpatient services, but men were more likely to be seen by mental health professionals. Nearly one-half of women's mental health visits were made in the general medical sector, suggesting that primary physicians play a disproportionate role in the treatment of women's mental health problems as compared to men's. More than two-thirds of all prescriptions for psychotropic drugs were for women. Although women made up 58% of all visits to physicians' offices, they received 73% of all prescriptions written for psychotropic medications (and 90% when the prescribing physician was not a psychiatrist). Although twice as many women as men were treated for depression, the depression literature suggests that it is the men rather than the women who benefit most from the antidepressant drugs.
In June, 1998 the National Center on Addiction and Substance Abuse at Columbia University released their report Under The Rug: Substance Abuse and The Mature Woman. Relevant Highlights: The destructive relationship between depression and alcohol abuse is particularly strong among women. At any age, alcoholic females are twice as likely as non-alcoholic females to be depressed and almost four times likelier than male alcoholics to be depressed. Inappropriate prescribing is common and can contribute to abuse and addiction. One out of six Medicare beneficiaries (3.5 million mature women) receives at least one inappropriate prescription. For many psychologists, social justice, by ensuring that the highest quality of care will be provided, has always been the critical vision behind RxP.
Prescriptive Authority (RxP): "It was 19 years ago now that we first developed the Fairleigh Dickinson Clinical Psychopharmacology program to provide training in preparation for prescriptive authority completely online. In 2002 we converted it to a Master's program, making it the second distance program offering a degree after Alliant University, the same year New Mexico became the first state to pass RxP legislation. When Louisiana passed its legislation in 2004, we saw the dominoes starting to fall and thought the critical mass would come soon. We had no idea how long it would be till the third state (Illinois) would join the club in 2014, which we owe to the great work done by Beth Rom-Rymer. Despite the long dry spell, the program has enrolled a new class every year for almost 20 years. I finally stepped down as Director in 2015, with Anne Farrar-Anton carrying the torch since then, though I still provide backup in my role as the Director of the School of Psychology. The program continues to evolve: our latest challenge has to do with how we would deal with the unique medical rotations requirement in the Illinois law, and we're working on the solution right now. The recent addition of Iowa and Idaho to the club tells us that maybe the critical mass is finally here, and we look forward to continuing to help psychologists from all over the country prepare themselves for that day" (Bob McGrath).
Maturing Successes: Iowa -- "As part of the legislation for prescriptive authority for psychologists in Iowa, we needed to create the administrative rules jointly with the Board of Medicine (BOM). In September, 2016 members appointed by the BOM and members appointed by the Board of Psychology (BOP) met for the first time to determine rules each group could support to their larger boards respectively. From September, 2016 until April, 2018 this sub-committee met regularly. There was considerable discussion regarding the training required. The fact that the post-doctoral master's degree programs are not yet accredited was difficult for our medical folks to understand. Conversations with APA about the process of accreditation compared to designation were held and Cathi Grus was very helpful in creating a comparison hand-out for the BOM members to visualize the similarities in each process. Once consensus on the degree program was reached, the practicum and supervision years were discussed. While this did not present as much of a challenge, there were still some intense conversations about who could be a training physician, a supervising physician, and a collaborating physician. In the end, the sub-committees reached consensus in April, 2018 and the rules as proposed were sent to the full Boards. At the June, 2018 BOM meeting they voted to notice the proposed rules for public comment and the BOP did the same.
"The public hearing was held August 21, 2018. At the hearing, the same concerns and suggestions from the opposing medical groups were heard. These were the same suggestions for amendments heard during the legislative sessions. Over the course of the BOM meetings in September and October, a couple of amendments were made to be more clear about releases of information and which physician involved with the training of the psychologist was responsible for what activity. On December 14, 2018 the BOM voted to adopt the rules as amended and on December 21, 2018 the BOP voted the same. These adopted rules were then filed by December 26th for notice on January 16th, 2019. The notice period of 20 days was concluded February 5th and the Administrative Rules Review Committee (ARRC) of the legislature met on February 8, 2019. The week prior to this meeting, some members of the ARRC were approached by the lobbyist of the Iowa Psychiatric Society who was requesting a session delay on the rules. There was some quick action taken to summarize the events of the past 2.5 years for the committee and ultimately, the rules were adopted without fanfare on February 8th. This was a long and challenging process and would not have been accomplished without the help and support of many, many people" (Bethe Lonning).
Connecticut -- "RxP is rolling along in the cold and snowy State of Connecticut early in March, 2019! You might recall that last year we were granted a Request for Review of Scope of Practice by the CT Department of Public Health (DPH). After a series of meetings with DPH and health care organizations (e.g., MDs, APRNs, Hospital Association, etc.), we engaged in 'discussions' and DPH reported on it all to the legislature. Since then, we have continued to advocate. In early February we had a 'Speed-Dating for Advocating' meeting with the Co-Chairs, a Vice Chair, and a Ranking Member (a physician) of the Public Health Committee (PHC), all of whom were knowledgeable and open to conversation.
"Then, later in the month, we received great news! The PHC of the CT State Legislature agreed to sponsor a bill, SB 966 An Act Concerning The Prescriptive Authority of Psychologists. The Public Hearing has not yet been scheduled, but will be within the next few weeks. We are proud and excited that CT is willing to take this step. We've still got a long way to go, that's for sure. But for now, get the snow mobile going!" (Barbara Bunk, Co-Chair).
Florida -- "In Florida we now have multiple sponsors and cosponsors in the Florida House and Senate. Legislative Day will occur in a few weeks and our Florida Psychological Association (FPA) members will meet with their local legislators to drum up support. We continue to gather information and answer questions for our legislators. We are very encouraged by the progress we've made to date and the support we're receiving from our elected representatives who tend to see this as a 'freedom of choice' issue. The White House released a report at the end of 2018 entitled Reforming America's Healthcare System Through Choice and Competition authored by the Secretaries of the Departments of Health and Human Services, Treasury, and Labor. It states in part:
"'As health care spending continues to rise, Americans are not receiving the commensurate benefit of living longer, healthier lives. Health care bills are too complex, choices are too restrained, and the insurance premiums and out-of-pocket costs are climbing faster than wages and tax revenue. Health care markets could work more efficiently and Americans could receive more effective, high-value care if we remove and revise certain federal and state regulations and policies that inhibit choice and competition…. Reduced competition among clinicians leads to higher prices for health care services, reduces choice, and negatively impacts overall health care quality and the efficient allocation of resources. Government policies have suppressed competition by reducing the available supply of providers and restricting the range of services that they can offer. This report recommends policies that will broaden providers' scope of practice [SOP] while improving workforce mobility, including telehealth, to encourage innovation and to allow providers more easily to meet patients' needs…. States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set.' It seems to me that we psychologists are on the right side of history. The times they are, indeed, changing" (Steve Ragusea).
Illinois – "At the Illinois Sixth Biannual Prescriptive Authority Networking event on Saturday night, February 2nd, I had the great honor and privilege of being given recognition as an 'Outstanding Leader' from the CEO of AMITA Health, one of our most important partners in the implementation of our Prescriptive Authority legislation in Illinois. With over 92 people, that included 20 students, interested in pursuing training to become prescribing psychologists; four of the 10 graduate students who are pursuing the joint degree in Clinical Psychopharmacology and Clinical Psychology; 15 of the more than 50 licensed psychologists who are currently doing their didactic training to become prescribing psychologists; five of the 10 psychologists who are currently doing their medical rotations; and the psychologist who is just a few months away from receiving his prescribing license; it was an exciting, electric evening.
"To begin the evening's program, we had two inspiring and dynamic keynote speakers, who very well articulated the connection between the needs of the most vulnerable and underserved populations in our society and the burgeoning presence of prescribing psychologists: a great community partner, Mark Ishaug, President and CEO of Thresholds, the largest and oldest social service agency in Illinois, that works with the most seriously mentally ill population in our state; and a wonderful psychologist colleague, Morgan Sammons, retired Navy Captain, in the first cohort of military psychologists who were trained as prescribers in 1992, formerly Dean of CSPP, Alliant International University, and now Executive Officer of the National Register of Health Service Psychologists.
"Following our keynote speakers, the practicing psychologists spoke about their training in Clinical Psychopharmacology (CP); then, the graduate students talked about the incredibly broadening experience of their training in CP at the pre-doctoral level. Finally, the large group of 20 graduate students talked about their interest in studying CP and their reasons for wanting to become prescribing psychologists. What we most heard was that these young students wanted opportunities to work, more effectively, with communities who have been chronically underserved. Since this was our Sixth Prescriptive Authority Networking event. Illinois psychologists, interested in pursuing Prescriptive Authority, came to renew and create important collegial relationships. It's not unusual for our psychologists to find long lost friends and colleagues at our events!
"Our APA Convention will be in Chicago this summer! I am, therefore, scheduling our Prescriptive Authority Networking event for August 11th, the Sunday of Convention, and extending our welcome to include psychologist participants from all around the country! Our Prescriptive Authority Movement has partnered with powerful community healthcare systems, like AMITA Health, and associations that serve the most underserved populations in our State, including Thresholds and NAMI. On August 11th, our APA CEO, Arthur Evans, will speak, as will our APA President Rosie Phillips Davis. In addition, we will have our Illinois community partners; our state legislative champions; our prescribing psychologists; our young graduate student trainees and older, practicing prescribing psychology trainees speak. I am thrilled to demonstrate, to our larger community, how Illinois psychologists are training for the future!" (Beth Rom-Rymer).
Reflections: "Talk about memory lane. The WMHA conference was an outgrowth of the work of the Subpanel on the Mental Health of Women of President Carter's Commission on Mental Health. Being co-chair of that Subpanel with psychiatrist Elaine Carmen, I met and learned from the 'stars' of the women's health movement across the health professions and applied those lessons in my role as Head of the Women's Programs Office at APA and Chair of the National Coalition for Women's Mental Health.
"1. The 'facts' are only the beginning. After completing our work documenting the impact of women's roles and circumstances on their mental health, the word got back to us that the entrenched power structure of the NIMH basically patronized and dismissed social determinants of women's behavior; the biomedical model reigned. It was not to be borne. I obtained a conference grant from the Ittleson Foundation and we were off and running.
"2. Clear goals and the power to achieve them are essential for a conference to produce actual social change. With the Subpanel report, we didn't need yet another research conference. What we needed was to build an advocacy framework and unified message to get our allies in prevailing power structures (e.g., professional associations and women's advocacy groups) on board to push for specific changes. The formula to constructing a conference leading to actual change was having the right mix of leaders, a leadership structure for follow-up, and a bit of sleight of hand – and we pulled it off. The WMHA was crafted and the National Coalition for Women's Mental Health was born.
"3. The conference's inclusive selection process was a key component for long term success. Having diverse voices at the table when discussing women's roles and circumstances is essential for the perspective-taking needed to generate effective prevention and intervention strategies. In constructing the conference, we not only had a separate working group focusing on special populations, we had individuals (professionals and advocates) from such populations represented in all the groups. The cross fertilization of ideas across the disciplines and life experiences was energizing. We weren't agonizing, we were organizing! We were individuals who shared core values who recognized that women's roles and life contexts were not conducive to mental health -- of women or men" (Nancy).
"You brought me back in time. The mental health agenda we proposed has given birth to some positive changes – women included in earlier stages of drug testing to see if effective, violence against women taken more seriously, PTSD enlarged as a concept to include the rape experience and other traumas likely to affect women. But there remain topics that we raised that still affect women's mental health – the role of stress of combining work and family (much less combining leadership and family) without social supports, the stereotype that shapes whether we see women as authority figures, how clinicians respond to women's and men's same presenting symptoms differently. My best to my partners of 1985" (Angela). Aloha,
Pat DeLeon, former APA President – Division 55 – March, 2019
Sent from my iPhone
Wednesday, May 8, 2019
ALOHA
LOOKING BACK -- MOTIVATION FOR MOVING FORWARD
In September, 1985 APA published A Women’s Mental Health Agenda, under the editorship of Nancy Felipe Russo, following up on a conference to assess the status of women’s mental health needs, identify priority areas, and create an interdisciplinary network to facilitate implementation of their recommendations. Participating in the conference were former APA Presidents Florence Denmark and Bonnie Strickland; as well as Angie McBride, a nurse-psychologist who served as Dean of the Indiana University School of Nursing and is one of nursing’s Living Legends. Those interested in psychology’s prescriptive (RxP) authority quest should seriously consider whether significant progress has really been made in our nation’s mental health delivery system over the past three decades. Highlights of their visionary report:
Research, education and training, and prevention programs were seen as tools for change. Increasing the participation of women at all levels in the mental health delivery system – as providers and as policymakers – was seen as the first step. That participation was considered a necessary condition for eliminating sex bias and sex role stereotyping in the delivery of mental health services. Developing appropriate diagnosis, treatment, rehabilitation, and prevention strategies requires recognition of the impact of the social context on women’s mental health, a position that challenges traditional intrapsychic, biomedical approaches to mental disorder. The call for strong interdisciplinary collaboration foretells today’s emphasis on Interprofessional Education (IPE), a personal priority of former APA President Susan McDaniel, as well as reflecting her focus on integrated care.
Women were more likely than men to use mental health services, particularly outpatient services, but men were more likely to be seen by mental health professionals. Nearly one-half of women’s mental health visits were made in the general medical sector, suggesting that primary physicians play a disproportionate role in the treatment of women’s mental health problems as compared to men’s. More than two-thirds of all prescriptions for psychotropic drugs were for women. Although women made up 58% of all visits to physicians’ offices, they received 73% of all prescriptions written for psychotropic medications (and 90% when the prescribing physician was not a psychiatrist). Although twice as many women as men were treated for depression, the depression literature suggests that it is the men rather than the women who benefit most from the antidepressant drugs.
In June, 1998 the National Center on Addiction and Substance Abuse at Columbia University released their report Under The Rug: Substance Abuse and The Mature Woman. Relevant Highlights: The destructive relationship between depression and alcohol abuse is particularly strong among women. At any age, alcoholic females are twice as likely as non-alcoholic females to be depressed and almost four times likelier than male alcoholics to be depressed. Inappropriate prescribing is common and can contribute to abuse and addiction. One out of six Medicare beneficiaries (3.5 million mature women) receives at least one inappropriate prescription. For many psychologists, social justice, by ensuring that the highest quality of care will be provided, has always been the critical vision behind RxP.
Prescriptive Authority (RxP): “It was 19 years ago now that we first developed the Fairleigh Dickinson Clinical Psychopharmacology program to provide training in preparation for prescriptive authority completely online. In 2002 we converted it to a Master’s program, making it the second distance program offering a degree after Alliant University, the same year New Mexico became the first state to pass RxP legislation. When Louisiana passed its legislation in 2004, we saw the dominoes starting to fall and thought the critical mass would come soon. We had no idea how long it would be till the third state (Illinois) would join the club in 2014, which we owe to the great work done by Beth Rom-Rymer. Despite the long dry spell, the program has enrolled a new class every year for almost 20 years. I finally stepped down as Director in 2015, with Anne Farrar-Anton carrying the torch since then, though I still provide backup in my role as the Director of the School of Psychology. The program continues to evolve: our latest challenge has to do with how we would deal with the unique medical rotations requirement in the Illinois law, and we’re working on the solution right now. The recent addition of Iowa and Idaho to the club tells us that maybe the critical mass is finally here, and we look forward to continuing to help psychologists from all over the country prepare themselves for that day” (Bob McGrath).
Maturing Successes: Iowa -- “As part of the legislation for prescriptive authority for psychologists in Iowa, we needed to create the administrative rules jointly with the Board of Medicine (BOM). In September, 2016 members appointed by the BOM and members appointed by the Board of Psychology (BOP) met for the first time to determine rules each group could support to their larger boards respectively. From September, 2016 until April, 2018 this sub-committee met regularly. There was considerable discussion regarding the training required. The fact that the post-doctoral master’s degree programs are not yet accredited was difficult for our medical folks to understand. Conversations with APA about the process of accreditation compared to designation were held and Cathi Grus was very helpful in creating a comparison hand-out for the BOM members to visualize the similarities in each process. Once consensus on the degree program was reached, the practicum and supervision years were discussed. While this did not present as much of a challenge, there were still some intense conversations about who could be a training physician, a supervising physician, and a collaborating physician. In the end, the sub-committees reached consensus in April, 2018 and the rules as proposed were sent to the full Boards. At the June, 2018 BOM meeting they voted to notice the proposed rules for public comment and the BOP did the same.
“The public hearing was held August 21, 2018. At the hearing, the same concerns and suggestions from the opposing medical groups were heard. These were the same suggestions for amendments heard during the legislative sessions. Over the course of the BOM meetings in September and October, a couple of amendments were made to be more clear about releases of information and which physician involved with the training of the psychologist was responsible for what activity. On December 14, 2018 the BOM voted to adopt the rules as amended and on December 21, 2018 the BOP voted the same. These adopted rules were then filed by December 26th for notice on January 16th, 2019. The notice period of 20 days was concluded February 5th and the Administrative Rules Review Committee (ARRC) of the legislature met on February 8, 2019. The week prior to this meeting, some members of the ARRC were approached by the lobbyist of the Iowa Psychiatric Society who was requesting a session delay on the rules. There was some quick action taken to summarize the events of the past 2.5 years for the committee and ultimately, the rules were adopted without fanfare on February 8th. This was a long and challenging process and would not have been accomplished without the help and support of many, many people” (Bethe Lonning).
Connecticut -- “RxP is rolling along in the cold and snowy State of Connecticut early in March, 2019! You might recall that last year we were granted a Request for Review of Scope of Practice by the CT Department of Public Health (DPH). After a series of meetings with DPH and health care organizations (e.g., MDs, APRNs, Hospital Association, etc.), we engaged in ‘discussions’ and DPH reported on it all to the legislature. Since then, we have continued to advocate. In early February we had a ‘Speed-Dating for Advocating’ meeting with the Co-Chairs, a Vice Chair, and a Ranking Member (a physician) of the Public Health Committee (PHC), all of whom were knowledgeable and open to conversation.
“Then, later in the month, we received great news! The PHC of the CT State Legislature agreed to sponsor a bill, SB 966 An Act Concerning The Prescriptive Authority of Psychologists. The Public Hearing has not yet been scheduled, but will be within the next few weeks. We are proud and excited that CT is willing to take this step. We’ve still got a long way to go, that’s for sure. But for now, get the snow mobile going!” (Barbara Bunk, Co-Chair).
Florida -- “In Florida we now have multiple sponsors and cosponsors in the Florida House and Senate. Legislative Day will occur in a few weeks and our Florida Psychological Association (FPA) members will meet with their local legislators to drum up support. We continue to gather information and answer questions for our legislators. We are very encouraged by the progress we’ve made to date and the support we’re receiving from our elected representatives who tend to see this as a ‘freedom of choice’ issue. The White House released a report at the end of 2018 entitled Reforming America’s Healthcare System Through Choice and Competition authored by the Secretaries of the Departments of Health and Human Services, Treasury, and Labor. It states in part:
“‘As health care spending continues to rise, Americans are not receiving the commensurate benefit of living longer, healthier lives. Health care bills are too complex, choices are too restrained, and the insurance premiums and out-of-pocket costs are climbing faster than wages and tax revenue. Health care markets could work more efficiently and Americans could receive more effective, high-value care if we remove and revise certain federal and state regulations and policies that inhibit choice and competition…. Reduced competition among clinicians leads to higher prices for health care services, reduces choice, and negatively impacts overall health care quality and the efficient allocation of resources. Government policies have suppressed competition by reducing the available supply of providers and restricting the range of services that they can offer. This report recommends policies that will broaden providers’ scope of practice [SOP] while improving workforce mobility, including telehealth, to encourage innovation and to allow providers more easily to meet patients’ needs…. States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set.’ It seems to me that we psychologists are on the right side of history. The times they are, indeed, changing” (Steve Ragusea).
Illinois – “At the Illinois Sixth Biannual Prescriptive Authority Networking event on Saturday night, February 2nd, I had the great honor and privilege of being given recognition as an ‘Outstanding Leader’ from the CEO of AMITA Health, one of our most important partners in the implementation of our Prescriptive Authority legislation in Illinois. With over 92 people, that included 20 students, interested in pursuing training to become prescribing psychologists; four of the 10 graduate students who are pursuing the joint degree in Clinical Psychopharmacology and Clinical Psychology; 15 of the more than 50 licensed psychologists who are currently doing their didactic training to become prescribing psychologists; five of the 10 psychologists who are currently doing their medical rotations; and the psychologist who is just a few months away from receiving his prescribing license; it was an exciting, electric evening.
“To begin the evening’s program, we had two inspiring and dynamic keynote speakers, who very well articulated the connection between the needs of the most vulnerable and underserved populations in our society and the burgeoning presence of prescribing psychologists: a great community partner, Mark Ishaug, President and CEO of Thresholds, the largest and oldest social service agency in Illinois, that works with the most seriously mentally ill population in our state; and a wonderful psychologist colleague, Morgan Sammons, retired Navy Captain, in the first cohort of military psychologists who were trained as prescribers in 1992, formerly Dean of CSPP, Alliant International University, and now Executive Officer of the National Register of Health Service Psychologists.
“Following our keynote speakers, the practicing psychologists spoke about their training in Clinical Psychopharmacology (CP); then, the graduate students talked about the incredibly broadening experience of their training in CP at the pre-doctoral level. Finally, the large group of 20 graduate students talked about their interest in studying CP and their reasons for wanting to become prescribing psychologists. What we most heard was that these young students wanted opportunities to work, more effectively, with communities who have been chronically underserved. Since this was our Sixth Prescriptive Authority Networking event. Illinois psychologists, interested in pursuing Prescriptive Authority, came to renew and create important collegial relationships. It’s not unusual for our psychologists to find long lost friends and colleagues at our events!
“Our APA Convention will be in Chicago this summer! I am, therefore, scheduling our Prescriptive Authority Networking event for August 11th, the Sunday of Convention, and extending our welcome to include psychologist participants from all around the country! Our Prescriptive Authority Movement has partnered with powerful community healthcare systems, like AMITA Health, and associations that serve the most underserved populations in our State, including Thresholds and NAMI. On August 11th, our APA CEO, Arthur Evans, will speak, as will our APA President Rosie Phillips Davis. In addition, we will have our Illinois community partners; our state legislative champions; our prescribing psychologists; our young graduate student trainees and older, practicing prescribing psychology trainees speak. I am thrilled to demonstrate, to our larger community, how Illinois psychologists are training for the future!” (Beth Rom-Rymer).
Reflections: “Talk about memory lane. The WMHA conference was an outgrowth of the work of the Subpanel on the Mental Health of Women of President Carter’s Commission on Mental Health. Being co-chair of that Subpanel with psychiatrist Elaine Carmen, I met and learned from the ‘stars’ of the women’s health movement across the health professions and applied those lessons in my role as Head of the Women’s Programs Office at APA and Chair of the National Coalition for Women’s Mental Health.
“1. The ‘facts’ are only the beginning. After completing our work documenting the impact of women’s roles and circumstances on their mental health, the word got back to us that the entrenched power structure of the NIMH basically patronized and dismissed social determinants of women’s behavior; the biomedical model reigned. It was not to be borne. I obtained a conference grant from the Ittleson Foundation and we were off and running.
“2. Clear goals and the power to achieve them are essential for a conference to produce actual social change. With the Subpanel report, we didn’t need yet another research conference. What we needed was to build an advocacy framework and unified message to get our allies in prevailing power structures (e.g., professional associations and women’s advocacy groups) on board to push for specific changes. The formula to constructing a conference leading to actual change was having the right mix of leaders, a leadership structure for follow-up, and a bit of sleight of hand – and we pulled it off. The WMHA was crafted and the National Coalition for Women’s Mental Health was born.
“3. The conference’s inclusive selection process was a key component for long term success. Having diverse voices at the table when discussing women’s roles and circumstances is essential for the perspective-taking needed to generate effective prevention and intervention strategies. In constructing the conference, we not only had a separate working group focusing on special populations, we had individuals (professionals and advocates) from such populations represented in all the groups. The cross fertilization of ideas across the disciplines and life experiences was energizing. We weren’t agonizing, we were organizing! We were individuals who shared core values who recognized that women’s roles and life contexts were not conducive to mental health -- of women or men” (Nancy).
“You brought me back in time. The mental health agenda we proposed has given birth to some positive changes – women included in earlier stages of drug testing to see if effective, violence against women taken more seriously, PTSD enlarged as a concept to include the rape experience and other traumas likely to affect women. But there remain topics that we raised that still affect women’s mental health – the role of stress of combining work and family (much less combining leadership and family) without social supports, the stereotype that shapes whether we see women as authority figures, how clinicians respond to women’s and men’s same presenting symptoms differently. My best to my partners of 1985” (Angela). Aloha,
Pat DeLeon, former APA President – Division 55 – March, 2019
Friday, April 26, 2019
WE’VE COME A LONG WAY FROM THE DAYS….
Forever Expanding the Boundaries of What is Possible: As Steve Ragusea emphasized over a decade ago, those colleagues within the Department of Defense (DOD) who were willing to take a chance on becoming the pioneering prescribing psychologists (RxP) effectively demonstrated for the profession that they could be trained to provide high quality, cost-effective psychopharmacological care. Today's advocates should appreciate the lasting contributions of retired military officers U.S. Navy Morgan Sammons and John Sexton; U.S. Army Anita Brown and Debra Dunivin; and U.S. Air Force Elaine Foster and Jim Meredith. Without their vision and dedication, we would never have come so far.
APA Board of Directors member Beth Rom-Rymer: "In 1996, APA Council was asked to pass a Resolution that would give the APA imprimatur to a new specialization: prescribing psychologists. After much discussion, Council voted to authorize the training of prescribing psychologists, but only after attaining licensure as clinical psychologists. Any pre-licensure in Clinical Psychopharmacology would be invalidated. The Council members' concern was that prescribing psychologists might dilute their identities as clinical psychologists if they were to train in Clinical Psychopharmacology while pursuing their doctorates in clinical psychology.
"Excited about the APA resolution, NOVA Southeastern University, from 2001-2009, offered training in Clinical Psychopharmacology at the graduate level as well as at the post-doctoral level. While APA had not approved the training at the graduate level, NOVA professors, particularly Eugene Shapiro, firmly believed that graduate students would benefit from doing their didactic training while still in graduate school. Therefore, several professors, including William (Joe) Burns and Lenora Walker, conducted outcome research on their students. They, indeed, found that the graduate students did at least as well on the course exams as the older, more experienced clinicians and identity as a 'psychologist' was not compromised.
"Bob Ax, Bob Resnick, and I, along with Gene, Lenora and Joe, and other NOVA faculty were early advocates for prescribing psychology trainees having access to the didactic training at the pre-doctoral, graduate level. It made sense to us that graduate students would appreciate the opportunity to begin their training in Clinical Psychopharmacology while still in school! It also made sense that while older clinicians could certainly go back to school to earn their Master's (MS) degree, the hardship of returning to school, and putting aside their full-time career and family responsibilities could be avoided. Given some of our experience in the training of prescribing psychology trainees, the psychologist's 'identity' was not threatened.
"In 2011, as I was preparing, with my team at the Illinois Psychological Association, to organize psychologists in the pursuit of RxP legislation in our state, I arranged a meeting for advocates, from around the country, to talk with Katherine Nordal, then-Executive Director of the APA Practice Directorate. The salient issue on the agenda was pre-doctoral training in Clinical Psychopharmacology. Katherine's brilliant suggestion was that we do the Master of Science degree in Clinical Psychopharmacology, and the doctorate in Clinical Psychology, as 'joint degrees,' just as psychologists do joint degrees in law, public policy, nursing, or business.
"In our Illinois Prescriptive Authority legislation, we merely omitted the word 'postdoctoral' when we discussed the education and training of the prescribing psychologist. While legislators worried about the quality of the teaching and the clinical supervision and the breath of clinical training, there was never any concern that our didactic training in Clinical Psychopharmacology would be done simultaneously with the Psychology doctorate.
"When our Illinois legislation passed in 2014, we not only had requirements for the Master's degree in Clinical Psychopharmacology, but we also had seven undergraduate physical science course requirements and a series of nine rotations in various medical specialties, over a period of not less than 14 months, at no less than 20 hours a week. At the same time, our Illinois law was unique, among other prescribing states, in that it allowed graduate students to do their Master's degrees in Clinical Psychopharmacology while still in graduate school.
"Our next hurdle was to persuade a university to offer training to graduate students in Clinical Psychopharmacology, even though the APA would not approve or 'designate' such a program. I will be forever grateful to The Chicago School of Professional Psychology, in Chicago, that had the courage to provide this graduate training. Its Director, Gerardo Rodruiguez-Menendez, is a graduate of that first NOVA Clinical Psychopharmacology training class. Never wanting to leave any stone unturned, we continued to work with APA for a 'Designation' criteria revision that would include pre-doctoral Clinical Psychopharmacology training.
"When the APA Designation criteria were scheduled to be reviewed, in its five year cycle, in 2017, the issue of doing the training at the graduate level was a high priority to be discussed. Elaine Foster, Marlin Hoover, Alan Lincoln, and Elaine LeVine, all prescribing psychologists and preeminent trainers of prescribing psychologists, were on the Task Force, and were in favor of this change. Accordingly, it is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists. One of the salient curriculum revisions was that the didactic portion of the training could be taken at the pre-doctoral graduate level.
"Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses. They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology, as graduate students, as are 10 current graduate students. Change can cause anxiety. Sometimes, it feels easier to stay in the same lane. But, just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities."
Futuristic Public Sector Training: The Uniformed Services University (USU) is the nation's only Federal graduate and undergraduate degree-granting health sciences university. It provides wonderful opportunities for cutting-edge training experiences. "Faculty at the USU Daniel K. Inouye Graduate School of Nursing (GSN) introduced me to the simulated training concept as a Psychiatric Mental Health Nurse Practitioner student. The idea of having actors as patients with curated medical histories while faculty and peers monitor my interaction sounded unnatural and outright nerve-racking. As I waited for my first encounter, I was fraught with anxious anticipation. However, once I greeted my live patient, the familiarity of the nurse-patient relationship grounded me, and I was able to focus on the task at hand. Three semesters in and counting, the Val G. Hemming Simulated Center's standardized patients continue to build my provider skills. As an added feature, the video capture allows me to playback cringe-worthy missteps at home. While at times unbearable to watch, it provides invaluable insight into areas I need to improve. Without a doubt, the controlled yet realistic simulations help guide me on the road to becoming a confident, compassionate and competent mental health provider" [Geraldine Waters, MAJ, ARMY, PMHNP Class of 2021].
"Similar to the PMHNP program, the Clinical Psychology program at USU uses the SIM Center and standardized patients (SPs) for formative learning and summative evaluation experiences. In assessment, cognitive and behavioral therapy, and brief dynamic courses, students practice assessment and intervention skills with the SPs. At the end of their third year, these students participate in an Objective Structured Clinical Examination (OSCE), which uses stations at the SIM Center to evaluate clinical skills in a systematic manner with a range of presenting problems as portrayed by the SPs. Faculty and the SPs evaluate the skills and provide feedback to students using competency evaluations. The opportunity to provide these experiences in an environment where errors do not affect the functioning of patients seeking care, provide a unique opportunity for student learning" [Jeff Goodie, CAPT. USPHS].
"When I visited the VA clinic in American Samoa, I was startled to learn they had been actively trying to fill a Psychiatric Mental Health Nurse Practitioner (PMHNP) position for four years without a single application. Ultimately, they found a PMHNP in Hawaii who was willing to telecommute. While it was disheartening to learn that the patients of American Samoa face such a shortage of on-island providers, I was encouraged to see telehealth technology fully functioning within the VA clinic. Their pharmacy as well as this new psychiatric role are both supported by off-island staff in Hawaii.
"This reminded me of the telehealth training I received at the Sim Center; the first time I experienced remote patient care firsthand. Although my 'patient' was just down the hall, the scenario was thoroughly planned so it seemed he was at home in a location far from my 'clinic.' This type of patient care is invaluable in the sense of access to services, but it adds an extra layer of communication challenges that are best overcome through training and practice. When considering how USU students could be better prepared to interact with patients in American Samoa, why not combine telehealth training with cultural competency? I recently learned of 'The American Samoa Society of Washington, DC,' whose mission is to 'foster enduring relationships with the common goal of sharing our Samoan values, culture, tradition, and native tongue.' Perhaps they would embrace portraying Samoan 'patients' during telehealth training" [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].
Unchartered Waters: We have come to appreciate that a number of colleagues currently engaged in public service are quite interested in also providing clinical services, perhaps on a part-time basis, through private practice. Jeff Barnett and Jeff Zimmerman recently published If You Build It They Will Come and Other Myths of Private Practice in the Mental Health Professions. Their enumerated twenty-nine myths to contemplate are practical, comprehensive, and even, at times, humorous. For example, "I am the boss. Who needs policies and procedures?" And, "If I treat my staff well, they will take care of me and look out for my best interests." At the annual APA convention, Rod Baker and I have been hosting a Division 18 symposium on Meaningful Retirement for an increasingly engaged audience. Many are contemplating continuing to be engaged in psychology; however, at a reduced level and undoubtedly in a new locus. Yet, few have any practical experience with the administrative complexities and legal/ethical aspects they will undoubtedly encounter. Former APA President Bob Resnick commented on their book: "This book anticipates virtually all the questions about going into independent practice. It will reduce your anxiety and provide reasoned guidance…." "But we still have a way to go" (Justice Ruth Bader Ginsburg). Aloha,
Pat DeLeon, former APA President – Division 18 – March, 2019
Sent from my iPhone
APA Board of Directors member Beth Rom-Rymer: "In 1996, APA Council was asked to pass a Resolution that would give the APA imprimatur to a new specialization: prescribing psychologists. After much discussion, Council voted to authorize the training of prescribing psychologists, but only after attaining licensure as clinical psychologists. Any pre-licensure in Clinical Psychopharmacology would be invalidated. The Council members' concern was that prescribing psychologists might dilute their identities as clinical psychologists if they were to train in Clinical Psychopharmacology while pursuing their doctorates in clinical psychology.
"Excited about the APA resolution, NOVA Southeastern University, from 2001-2009, offered training in Clinical Psychopharmacology at the graduate level as well as at the post-doctoral level. While APA had not approved the training at the graduate level, NOVA professors, particularly Eugene Shapiro, firmly believed that graduate students would benefit from doing their didactic training while still in graduate school. Therefore, several professors, including William (Joe) Burns and Lenora Walker, conducted outcome research on their students. They, indeed, found that the graduate students did at least as well on the course exams as the older, more experienced clinicians and identity as a 'psychologist' was not compromised.
"Bob Ax, Bob Resnick, and I, along with Gene, Lenora and Joe, and other NOVA faculty were early advocates for prescribing psychology trainees having access to the didactic training at the pre-doctoral, graduate level. It made sense to us that graduate students would appreciate the opportunity to begin their training in Clinical Psychopharmacology while still in school! It also made sense that while older clinicians could certainly go back to school to earn their Master's (MS) degree, the hardship of returning to school, and putting aside their full-time career and family responsibilities could be avoided. Given some of our experience in the training of prescribing psychology trainees, the psychologist's 'identity' was not threatened.
"In 2011, as I was preparing, with my team at the Illinois Psychological Association, to organize psychologists in the pursuit of RxP legislation in our state, I arranged a meeting for advocates, from around the country, to talk with Katherine Nordal, then-Executive Director of the APA Practice Directorate. The salient issue on the agenda was pre-doctoral training in Clinical Psychopharmacology. Katherine's brilliant suggestion was that we do the Master of Science degree in Clinical Psychopharmacology, and the doctorate in Clinical Psychology, as 'joint degrees,' just as psychologists do joint degrees in law, public policy, nursing, or business.
"In our Illinois Prescriptive Authority legislation, we merely omitted the word 'postdoctoral' when we discussed the education and training of the prescribing psychologist. While legislators worried about the quality of the teaching and the clinical supervision and the breath of clinical training, there was never any concern that our didactic training in Clinical Psychopharmacology would be done simultaneously with the Psychology doctorate.
"When our Illinois legislation passed in 2014, we not only had requirements for the Master's degree in Clinical Psychopharmacology, but we also had seven undergraduate physical science course requirements and a series of nine rotations in various medical specialties, over a period of not less than 14 months, at no less than 20 hours a week. At the same time, our Illinois law was unique, among other prescribing states, in that it allowed graduate students to do their Master's degrees in Clinical Psychopharmacology while still in graduate school.
"Our next hurdle was to persuade a university to offer training to graduate students in Clinical Psychopharmacology, even though the APA would not approve or 'designate' such a program. I will be forever grateful to The Chicago School of Professional Psychology, in Chicago, that had the courage to provide this graduate training. Its Director, Gerardo Rodruiguez-Menendez, is a graduate of that first NOVA Clinical Psychopharmacology training class. Never wanting to leave any stone unturned, we continued to work with APA for a 'Designation' criteria revision that would include pre-doctoral Clinical Psychopharmacology training.
"When the APA Designation criteria were scheduled to be reviewed, in its five year cycle, in 2017, the issue of doing the training at the graduate level was a high priority to be discussed. Elaine Foster, Marlin Hoover, Alan Lincoln, and Elaine LeVine, all prescribing psychologists and preeminent trainers of prescribing psychologists, were on the Task Force, and were in favor of this change. Accordingly, it is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists. One of the salient curriculum revisions was that the didactic portion of the training could be taken at the pre-doctoral graduate level.
"Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses. They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology, as graduate students, as are 10 current graduate students. Change can cause anxiety. Sometimes, it feels easier to stay in the same lane. But, just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities."
Futuristic Public Sector Training: The Uniformed Services University (USU) is the nation's only Federal graduate and undergraduate degree-granting health sciences university. It provides wonderful opportunities for cutting-edge training experiences. "Faculty at the USU Daniel K. Inouye Graduate School of Nursing (GSN) introduced me to the simulated training concept as a Psychiatric Mental Health Nurse Practitioner student. The idea of having actors as patients with curated medical histories while faculty and peers monitor my interaction sounded unnatural and outright nerve-racking. As I waited for my first encounter, I was fraught with anxious anticipation. However, once I greeted my live patient, the familiarity of the nurse-patient relationship grounded me, and I was able to focus on the task at hand. Three semesters in and counting, the Val G. Hemming Simulated Center's standardized patients continue to build my provider skills. As an added feature, the video capture allows me to playback cringe-worthy missteps at home. While at times unbearable to watch, it provides invaluable insight into areas I need to improve. Without a doubt, the controlled yet realistic simulations help guide me on the road to becoming a confident, compassionate and competent mental health provider" [Geraldine Waters, MAJ, ARMY, PMHNP Class of 2021].
"Similar to the PMHNP program, the Clinical Psychology program at USU uses the SIM Center and standardized patients (SPs) for formative learning and summative evaluation experiences. In assessment, cognitive and behavioral therapy, and brief dynamic courses, students practice assessment and intervention skills with the SPs. At the end of their third year, these students participate in an Objective Structured Clinical Examination (OSCE), which uses stations at the SIM Center to evaluate clinical skills in a systematic manner with a range of presenting problems as portrayed by the SPs. Faculty and the SPs evaluate the skills and provide feedback to students using competency evaluations. The opportunity to provide these experiences in an environment where errors do not affect the functioning of patients seeking care, provide a unique opportunity for student learning" [Jeff Goodie, CAPT. USPHS].
"When I visited the VA clinic in American Samoa, I was startled to learn they had been actively trying to fill a Psychiatric Mental Health Nurse Practitioner (PMHNP) position for four years without a single application. Ultimately, they found a PMHNP in Hawaii who was willing to telecommute. While it was disheartening to learn that the patients of American Samoa face such a shortage of on-island providers, I was encouraged to see telehealth technology fully functioning within the VA clinic. Their pharmacy as well as this new psychiatric role are both supported by off-island staff in Hawaii.
"This reminded me of the telehealth training I received at the Sim Center; the first time I experienced remote patient care firsthand. Although my 'patient' was just down the hall, the scenario was thoroughly planned so it seemed he was at home in a location far from my 'clinic.' This type of patient care is invaluable in the sense of access to services, but it adds an extra layer of communication challenges that are best overcome through training and practice. When considering how USU students could be better prepared to interact with patients in American Samoa, why not combine telehealth training with cultural competency? I recently learned of 'The American Samoa Society of Washington, DC,' whose mission is to 'foster enduring relationships with the common goal of sharing our Samoan values, culture, tradition, and native tongue.' Perhaps they would embrace portraying Samoan 'patients' during telehealth training" [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].
Unchartered Waters: We have come to appreciate that a number of colleagues currently engaged in public service are quite interested in also providing clinical services, perhaps on a part-time basis, through private practice. Jeff Barnett and Jeff Zimmerman recently published If You Build It They Will Come and Other Myths of Private Practice in the Mental Health Professions. Their enumerated twenty-nine myths to contemplate are practical, comprehensive, and even, at times, humorous. For example, "I am the boss. Who needs policies and procedures?" And, "If I treat my staff well, they will take care of me and look out for my best interests." At the annual APA convention, Rod Baker and I have been hosting a Division 18 symposium on Meaningful Retirement for an increasingly engaged audience. Many are contemplating continuing to be engaged in psychology; however, at a reduced level and undoubtedly in a new locus. Yet, few have any practical experience with the administrative complexities and legal/ethical aspects they will undoubtedly encounter. Former APA President Bob Resnick commented on their book: "This book anticipates virtually all the questions about going into independent practice. It will reduce your anxiety and provide reasoned guidance…." "But we still have a way to go" (Justice Ruth Bader Ginsburg). Aloha,
Pat DeLeon, former APA President – Division 18 – March, 2019
Sent from my iPhone
Thursday, April 25, 2019
Division 18 column -- ALOHA
“WE’VE COME A LONG WAY FROM THE DAYS….”
Forever Expanding the Boundaries of What is Possible: As Steve Ragusea emphasized over a decade ago, those colleagues within the Department of Defense (DOD) who were willing to take a chance on becoming the pioneering prescribing psychologists (RxP) effectively demonstrated for the profession that they could be trained to provide high quality, cost-effective psychopharmacological care. Today’s advocates should appreciate the lasting contributions of retired military officers U.S. Navy Morgan Sammons and John Sexton; U.S. Army Anita Brown and Debra Dunivin; and U.S. Air Force Elaine Foster and Jim Meredith. Without their vision and dedication, we would never have come so far.
APA Board of Directors member Beth Rom-Rymer: “In 1996, APA Council was asked to pass a Resolution that would give the APA imprimatur to a new specialization: prescribing psychologists. After much discussion, Council voted to authorize the training of prescribing psychologists, but only after attaining licensure as clinical psychologists. Any pre-licensure in Clinical Psychopharmacology would be invalidated. The Council members’ concern was that prescribing psychologists might dilute their identities as clinical psychologists if they were to train in Clinical Psychopharmacology while pursuing their doctorates in clinical psychology.
“Excited about the APA resolution, NOVA Southeastern University, from 2001-2009, offered training in Clinical Psychopharmacology at the graduate level as well as at the post-doctoral level. While APA had not approved the training at the graduate level, NOVA professors, particularly Eugene Shapiro, firmly believed that graduate students would benefit from doing their didactic training while still in graduate school. Therefore, several professors, including William (Joe) Burns and Lenora Walker, conducted outcome research on their students. They, indeed, found that the graduate students did at least as well on the course exams as the older, more experienced clinicians and identity as a ‘psychologist’ was not compromised.
“Bob Ax, Bob Resnick, and I, along with Gene, Lenora and Joe, and other NOVA faculty were early advocates for prescribing psychology trainees having access to the didactic training at the pre-doctoral, graduate level. It made sense to us that graduate students would appreciate the opportunity to begin their training in Clinical Psychopharmacology while still in school! It also made sense that while older clinicians could certainly go back to school to earn their Master’s (MS) degree, the hardship of returning to school, and putting aside their full-time career and family responsibilities could be avoided. Given some of our experience in the training of prescribing psychology trainees, the psychologist’s ‘identity’ was not threatened.
“In 2011, as I was preparing, with my team at the Illinois Psychological Association, to organize psychologists in the pursuit of RxP legislation in our state, I arranged a meeting for advocates, from around the country, to talk with Katherine Nordal, then-Executive Director of the APA Practice Directorate. The salient issue on the agenda was pre-doctoral training in Clinical Psychopharmacology. Katherine’s brilliant suggestion was that we do the Master of Science degree in Clinical Psychopharmacology, and the doctorate in Clinical Psychology, as ‘joint degrees,’ just as psychologists do joint degrees in law, public policy, nursing, or business.
“In our Illinois Prescriptive Authority legislation, we merely omitted the word ‘postdoctoral’ when we discussed the education and training of the prescribing psychologist. While legislators worried about the quality of the teaching and the clinical supervision and the breath of clinical training, there was never any concern that our didactic training in Clinical Psychopharmacology would be done simultaneously with the Psychology doctorate.
“When our Illinois legislation passed in 2014, we not only had requirements for the Master’s degree in Clinical Psychopharmacology, but we also had seven undergraduate physical science course requirements and a series of nine rotations in various medical specialties, over a period of not less than 14 months, at no less than 20 hours a week. At the same time, our Illinois law was unique, among other prescribing states, in that it allowed graduate students to do their Master’s degrees in Clinical Psychopharmacology while still in graduate school.
“Our next hurdle was to persuade a university to offer training to graduate students in Clinical Psychopharmacology, even though the APA would not approve or ‘designate’ such a program. I will be forever grateful to The Chicago School of Professional Psychology, in Chicago, that had the courage to provide this graduate training. Its Director, Gerardo Rodruiguez-Menendez, is a graduate of that first NOVA Clinical Psychopharmacology training class. Never wanting to leave any stone unturned, we continued to work with APA for a ‘Designation’ criteria revision that would include pre-doctoral Clinical Psychopharmacology training.
“When the APA Designation criteria were scheduled to be reviewed, in its five year cycle, in 2017, the issue of doing the training at the graduate level was a high priority to be discussed. Elaine Foster, Marlin Hoover, Alan Lincoln, and Elaine LeVine, all prescribing psychologists and preeminent trainers of prescribing psychologists, were on the Task Force, and were in favor of this change. Accordingly, it is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists. One of the salient curriculum revisions was that the didactic portion of the training could be taken at the pre-doctoral graduate level.
“Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses. They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology, as graduate students, as are 10 current graduate students. Change can cause anxiety. Sometimes, it feels easier to stay in the same lane. But, just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities.”
Futuristic Public Sector Training: The Uniformed Services University (USU) is the nation’s only Federal graduate and undergraduate degree-granting health sciences university. It provides wonderful opportunities for cutting-edge training experiences. “Faculty at the USU Daniel K. Inouye Graduate School of Nursing (GSN) introduced me to the simulated training concept as a Psychiatric Mental Health Nurse Practitioner student. The idea of having actors as patients with curated medical histories while faculty and peers monitor my interaction sounded unnatural and outright nerve-racking. As I waited for my first encounter, I was fraught with anxious anticipation. However, once I greeted my live patient, the familiarity of the nurse-patient relationship grounded me, and I was able to focus on the task at hand. Three semesters in and counting, the Val G. Hemming Simulated Center’s standardized patients continue to build my provider skills. As an added feature, the video capture allows me to playback cringe-worthy missteps at home. While at times unbearable to watch, it provides invaluable insight into areas I need to improve. Without a doubt, the controlled yet realistic simulations help guide me on the road to becoming a confident, compassionate and competent mental health provider” [Geraldine Waters, MAJ, ARMY, PMHNP Class of 2021].
“Similar to the PMHNP program, the Clinical Psychology program at USU uses the SIM Center and standardized patients (SPs) for formative learning and summative evaluation experiences. In assessment, cognitive and behavioral therapy, and brief dynamic courses, students practice assessment and intervention skills with the SPs. At the end of their third year, these students participate in an Objective Structured Clinical Examination (OSCE), which uses stations at the SIM Center to evaluate clinical skills in a systematic manner with a range of presenting problems as portrayed by the SPs. Faculty and the SPs evaluate the skills and provide feedback to students using competency evaluations. The opportunity to provide these experiences in an environment where errors do not affect the functioning of patients seeking care, provide a unique opportunity for student learning” [Jeff Goodie, CAPT. USPHS].
“When I visited the VA clinic in American Samoa, I was startled to learn they had been actively trying to fill a Psychiatric Mental Health Nurse Practitioner (PMHNP) position for four years without a single application. Ultimately, they found a PMHNP in Hawaii who was willing to telecommute. While it was disheartening to learn that the patients of American Samoa face such a shortage of on-island providers, I was encouraged to see telehealth technology fully functioning within the VA clinic. Their pharmacy as well as this new psychiatric role are both supported by off-island staff in Hawaii.
“This reminded me of the telehealth training I received at the Sim Center; the first time I experienced remote patient care firsthand. Although my ‘patient’ was just down the hall, the scenario was thoroughly planned so it seemed he was at home in a location far from my ‘clinic.’ This type of patient care is invaluable in the sense of access to services, but it adds an extra layer of communication challenges that are best overcome through training and practice. When considering how USU students could be better prepared to interact with patients in American Samoa, why not combine telehealth training with cultural competency? I recently learned of ‘The American Samoa Society of Washington, DC,’ whose mission is to ‘foster enduring relationships with the common goal of sharing our Samoan values, culture, tradition, and native tongue.’ Perhaps they would embrace portraying Samoan ‘patients’ during telehealth training” [Michelle Binder, Capt., USAF; Psychiatric Mental Health Practitioner graduate student].
Unchartered Waters: We have come to appreciate that a number of colleagues currently engaged in public service are quite interested in also providing clinical services, perhaps on a part-time basis, through private practice. Jeff Barnett and Jeff Zimmerman recently published If You Build It They Will Come and Other Myths of Private Practice in the Mental Health Professions. Their enumerated twenty-nine myths to contemplate are practical, comprehensive, and even, at times, humorous. For example, “I am the boss. Who needs policies and procedures?” And, “If I treat my staff well, they will take care of me and look out for my best interests.” At the annual APA convention, Rod Baker and I have been hosting a Division 18 symposium on Meaningful Retirement for an increasingly engaged audience. Many are contemplating continuing to be engaged in psychology; however, at a reduced level and undoubtedly in a new locus. Yet, few have any practical experience with the administrative complexities and legal/ethical aspects they will undoubtedly encounter. Former APA President Bob Resnick commented on their book: “This book anticipates virtually all the questions about going into independent practice. It will reduce your anxiety and provide reasoned guidance….” “But we still have a way to go” (Justice Ruth Bader Ginsburg). Aloha,
Pat DeLeon, former APA President – Division 18 – March, 2019
Wednesday, April 17, 2019
MEMORIES ARE MADE FROM THIS
Our state psychological associations have always been the key to advancing professional practice. Several of our executive directors, such as Ohio's Michael Ranney who has served since June of 1997, have been with psychology from the earliest years of Practice Leadership Conference, which in my judgment is the highlight of the year. Another visionary stalwart, Sally Cameron, recently retired after 38 years of serving the North Carolina Psychological Association (NCPA). Sally became the first NCPA Executive Director in January of 1981.
"It has been the honor of my career to serve as Executive Director. I am excited today as I was in 1981 about your profession and the contributions you make to the state and to society. As NCPA celebrated its 70th anniversary in 2018, it was a time for reflection. Together we accomplished a great deal, and there is still much more to be done. As I look back over my 38 years, how things have changed. From an office in my home to a rental space; from file cards to a computer with a database; from that rental space to our wonderful permanent headquarters in Raleigh; from being the only staff person to a staff of four plus our long time Director of Professional Affairs and our lobbyist; and much more.
"NCPA is an incredible organization. Psychology has been so fortunate to have so many members over my 38 years who have given an unbelievable amount of their time, talent and treasure to their professional organization. Working with each one has been a privilege and a pleasure. Traveling throughout the state to meet many psychologists at local gatherings and continuing education activities was such a joyous part of my role.
"I am very grateful to the support from APA, and particularly the Practice Organization; for state psychological associations; and for CESPPA, the professional organization for executive directors of state, provincial and territorial associations. The decision to retire was not easy – especially when you love what you do. But it was time – a time to spend even more time with my wonderful and ever so supportive husband Jim, more time with friends and family, and to do the psychologically healthy thing – rest and relax. I will miss NCPA but I know that with the commitment of the leaders and members, NCPA and psychology will continue to thrive for many years to come. Thanks for the memories" (Sally Cameron).
"Sally is an icon in the world of Executive Directors for psychological associations. Besides being a wonderful person she was a wonderful mentor to many including me during my time with both NCPA and APA. Psychology, and I, owe a debt of significant gratitude to Sally" (Tony Puente, former APA President).
Don't Forget a Small Moonbeam: APA Board of Directors member Beth Rom-Rymer: "It is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists. One of the salient curriculum revisions was that the didactic portion of the training could be taken at the predoctoral graduate level. Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses. They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology as graduate students. Just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities." Aloha, [Dean Martin].
Pat DeLeon, former APA President – Division 31 – March, 2019
"It has been the honor of my career to serve as Executive Director. I am excited today as I was in 1981 about your profession and the contributions you make to the state and to society. As NCPA celebrated its 70th anniversary in 2018, it was a time for reflection. Together we accomplished a great deal, and there is still much more to be done. As I look back over my 38 years, how things have changed. From an office in my home to a rental space; from file cards to a computer with a database; from that rental space to our wonderful permanent headquarters in Raleigh; from being the only staff person to a staff of four plus our long time Director of Professional Affairs and our lobbyist; and much more.
"NCPA is an incredible organization. Psychology has been so fortunate to have so many members over my 38 years who have given an unbelievable amount of their time, talent and treasure to their professional organization. Working with each one has been a privilege and a pleasure. Traveling throughout the state to meet many psychologists at local gatherings and continuing education activities was such a joyous part of my role.
"I am very grateful to the support from APA, and particularly the Practice Organization; for state psychological associations; and for CESPPA, the professional organization for executive directors of state, provincial and territorial associations. The decision to retire was not easy – especially when you love what you do. But it was time – a time to spend even more time with my wonderful and ever so supportive husband Jim, more time with friends and family, and to do the psychologically healthy thing – rest and relax. I will miss NCPA but I know that with the commitment of the leaders and members, NCPA and psychology will continue to thrive for many years to come. Thanks for the memories" (Sally Cameron).
"Sally is an icon in the world of Executive Directors for psychological associations. Besides being a wonderful person she was a wonderful mentor to many including me during my time with both NCPA and APA. Psychology, and I, owe a debt of significant gratitude to Sally" (Tony Puente, former APA President).
Don't Forget a Small Moonbeam: APA Board of Directors member Beth Rom-Rymer: "It is thrilling to announce that on February 17, 2019, 23 years after APA Council passed the first resolution on prescribing psychologists, Council approved updated proposals for education and training as preparation for becoming prescribing psychologists. One of the salient curriculum revisions was that the didactic portion of the training could be taken at the predoctoral graduate level. Our Illinois pipeline is full, with 75 undergraduate students taking their required pre-prescribing undergraduate science courses. They will have the opportunity to earn their joint degrees in Clinical Psychopharmacology and Clinical Psychology as graduate students. Just as men and women have evolved in their societal roles over the last several decades, we psychologists, too, are evolving and learning new ways in which we can expertly help the most-at-risk members of our communities." Aloha, [Dean Martin].
Pat DeLeon, former APA President – Division 31 – March, 2019
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