APA/APA Services’ Exciting Virtual Advocacy Summit

Alix Ginsberg, Senior Director Congressional & Federal Relations: “On March 26-27th, APA/APA Services’ hosted its first Virtual Advocacy Summit of 2023, ‘Strengthening the Psychology Workforce to Improve Health Equity.’  This Summit included over 200 psychologists from 49 states, as well as Puerto Rico and Washington, DC, and represented 13 APA Divisions and 44 State, Provincial, and Territorial Psychological Associations (SPTAs).  After a day of programming, interactive trainings, and meetings with their state delegations, advocates held meetings with their Congressional delegations to advocate for several policy solutions to help strengthen the psychology workforce, reduce health disparities, and help meet the nation’s growing demand for mental and behavioral health services. 

“On March 26th, APA President Thema Bryant and APA CEO Arthur Evans gave opening remarks, which were followed by a presentation on current political dynamics in the 118th Congress by APA Chief Advocacy Officer Katherine McGuire.  Summit participants then heard from experts through targeted panel discussions titled, Addressing Obstacles and Barriers to Health Equity in Underserved Areas and Reducing Health Disparities by Strengthening Support for Psychology Trainees.  These panels were moderated by APA President-Elect Cynthia de las Fuentes and D.C. Psychological Association President-Elect Jessica Smedley. 

“On March 27th, Summit participants met with Members of their Congressional delegations to advocate for three important legislative requests that would strengthen the psychology workforce.  These legislative requests included supporting the Increasing Mental Health Options Act (S. 669), which was recently introduced by Senators Brown (D-OH), Collins (R-ME), Heinrich (D-NM), and Mullin (R-OK).  S. 669 would allow psychologists in Medicare to practice independently in all covered treatment settings, as they are allowed to do under private sector health plans, in TRICARE, and within the VA.  Currently, Medicare does not allow psychologists to practice independently in an all Medicare-covered treatment setting.  They can practice independently in office-based settings, but for patients in skilled nursing facilities, partial hospitalization programs, outpatient rehabilitation facilities, home health agencies, and hospice programs patients need to obtain a physician referral before seeing a psychologist.  This creates unnecessary delays in treatment for Medicare patients in these settings.  In addition, advocates asked legislators to support legislation that would authorize reimbursement for supervised services provided by advanced psychology trainees in Medicare, which is expected to be introduced by Senators Barrasso (R-WY) and Bennet (D-CO) soon.  CMS has already approved reimbursement for these services in 28 states in Medicaid.  Finally, advocates also asked their Members of Congress to support increased FY24 funding for the Graduate Psychology Education (GPE) and Minority Fellowship Program (MFP).  These critical programs would strengthen our nation’s supply of health service psychologists trained to provide culturally competent, integrated mental and behavioral health services.” 

Psychology’s Increasing Expansion into the Health Care Arena

One of the most enjoyable aspects of being involved with the National Academy of Medicine (NAM) of the National Academies of Science, Engineering, and Medicine (NASEM) is the opportunity to learn from distinguished colleagues in other disciplines.  This is especially relevant for psychology’s continuing expansion as a primary health care provider and our active participation in team-based care.  It is the essence of Interprofessional Practice and Education (IPE). 

During one of our recent Global Forum on Innovation in Health Professional Education meetings, Kim Dunleavy, of the College of Public Health and Health Professions at the University of Florida and representative for the American College for Academic Physical Therapy Education, presented the perspective of the importance of interprofessional management for addressing “the high prevalence and major impact of pain as the number one cause of disability around the world.”  Her editorial in the Journal of Interprofessional Education & Practice stressed the importance of moving beyond society’s current focus on opioid use disorders to a more comprehensive prevention and use of best practices for pain management orientation, while noting that “health professionals are often ill prepared to assist patients effectively.” 

Highlights: The delivery of effective pain management can be complex, requiring collaborative approaches that exceed the expertise of any one profession to manage the cognitive, physical, and psychosocial aspects of pain management in a coordinated team approach.  Accordingly, interprofessional teamwork is critical for seamless, high quality patient care and effective management of pain.  Shared decision making with empathy and compassion is a core element of optimal interprofessional collaborative practice, as is respect for one’s colleagues.  Involving patients is especially important and developing effective training modules is a distinct challenge.  The professions involved in pain management at lease include chaplaincy, counselling, dentistry, medicine, medical assistants, nursing, pharmacy, physical therapy, psychology, public health, occupational therapy, and social work.  Some of the future directions emphasized in this special edition are an emphasis upon experiential learning, involving patients in co-creating and delivering effective services and learning experiences.  And these should include individuals who have lived experiences with pain.  The need for continuous evaluation of the various educational activities is important in developing data-based best practices.  Interestingly, our long-time colleague Bob Frank served as Dean of Kim’s College in 1995.  He was subsequently selected as a Robert Wood Johnson Health Policy Fellow and President of the University of New Mexico.  Most impressively, the College endowed the Dean’s Chair in his name. 

With the increasing and transformative utilization of cutting-edge technology, including telehealth services as described by Kim, licensure mobility has become a significant policy issue confronting the various health professions.  At the recent 40th annual Practice and State Leadership Conference (PLC/SLC), Alex Siegel, Director of Professional Affairs at the Association of State and Provincial Psychology Boards (ASPPB), reported that an increasing number of the other health professions are in the process of adopting a Compact approach for their membership, similar to the Psychological Interjurisdictional Compact (PSYPACT) which has now been adopted in 35 jurisdictions, 33 of which are currently effective.  Alex further noted the growing interest of the health professions community in working to modify the current reimbursement/payment system to emphasize demonstrable quality outcome measures, rather than continuing to relay upon the historical volume of services provided. 

Changing Times

Lucinda Maine, retired CEO of the American Association of Colleges of Pharmacy (AACP): “The College of Psychiatric and Neurologic Pharmacists (CPNP) was founded on March 24, 1999, when the network of pharmacists, formerly known as the Conference of Psychiatric and Neurologic Pharmacists, became a professional society.  The formation of CPNP was the cumulation of the efforts of many pharmacists practicing in the psychiatry and neurology specialties over the past 30 years.  In 2022, 50 years after the first psychiatric pharmacy residency was established, CPNP was renamed the American Association of Psychiatric Pharmacists (AAPP) to provide a clarity of purpose, enhance advocacy efforts, streamline planning strategies, and allow the organization to proceed with passion, focus, and authenticity.  AAPP serves a membership of nearly 3,000 individuals [https://aapp.org/about]. 

“During his AACP Presidency, J. Lyle Bootman reached out to national organizations and AACP joined forces with the American College of Clinical Pharmacy to market and launch a visionary initiative under which the NAM hosts a Pharmacy Health Policy Fellow.  The Fellows will tell you that it transformed their careers!”  This is a sentiment deeply shared by Bob Frank.  For those colleagues interested in psychology’s RxP quest, Bob McGrath, the founding chair of the RxP training program at Fairleigh Dickinson University, estimates that 7.33% of our nation presently has access to prescribing psychologists.  About half of whom are in Illinois, thanks to Beth Rom-Rymer’s continuing efforts. 

Ron Levant, former APA President: “Morgan Sammons and I have been discussing the need to re-envision the doctoral curriculum.  It takes about seven years to get a Ph.D. in health service psychology (i.e., counseling or clinical), because the curriculum is largely geared to training people for academic careers.  Yet very few graduates go into the academy.  The PsyD was intended to be a corrective, yet due to the requirements of the APA Commission on Accreditation, it has largely failed to do that.  That is, it has shaved very little off the time, taking about six years for the PsyD.  At the same time, master-level mental health professions (LCSW, LPC, MFT) are turning out scores of practitioners who provide psychotherapy, but not the advanced psycho-diagnostic and health-related services that psychologists are trained to provide. 

“In the meantime, medicine has dramatically revamped its curriculum, taking the two-year basic science curriculum and condensing it down into 11 months, and making it much more clinically relevant.  Morgan, in his role as CEO of the National Register, has been writing about this.  One of his columns can be found at [https://www.nationalregister.org/eo-desk-apr-2022-doctoral-curriculum/].  Both Morgan and I are retired, but we still want to do what we can to stimulate discussion of this matter.  As former University Deans, we would appreciate learning your thoughts [Levant@uakron.edu].” 

Exciting Opportunities for the Next Generation

CPT Airyn Nash, USU Psychology Graduate Student – “This was my first-time attending APA’s Practice Leadership Conference (PLC/SLC), and it was so inspiring to see the people and brains behind the policies and advocacy for psychologists throughout our nation.  As a first-year graduate student, I was extremely impressed by the APAGS representatives from each state and grateful that I could contribute to the conversations with some military experience and insight for a largely civilian population.  Among discussions for ways to increase access to care for those most at risk and impoverished, students also discussed ways to maximize therapy practices at both the master’s and doctoral level.  Most important of all, the care and passion for others and their well-being was tangibly present, and it left me hopeful for the continued future leadership of APA. 

“For myself, this was such a great opportunity to network and connect with psychologists who are interested in gaining prescriptive authority for their states.  I gained such a better understanding of the thought processes that go on behind the scenes to make change not only within the APA, but also in the state and federal legislations.  I cannot recommend this experience enough, especially for graduate students, in order to peer into the workings of our future profession.  I am deeply humbled by the opportunity to attend and be among peers and leaders within this field, and I would like to extend a ‘thank you’ to Dr. Abrahamson and the rest of the APA organizers for putting on a great event.”  “Ageless and ever evergreen” (Barbra Streisand).    

Aloha, 

Pat DeLeon, former APA President – Division 29 – April 2023 

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Pat DeLeon, Ph.D.

Pat DeLeon is the Distinguished Professor at the Uniformed Services University of the Health Sciences (DoD) in the School of Nursing and School of Medicine. He was elected to the Institute of Medicine of the National Academies of Science in 2008 and served as President of the American Psychological Association (APA) in 2000. For over 38 years he was on the staff of U.S. Senator Daniel K. Inouye (D-Hawaii) retiring as his Chief of Staff. He has received numerous national awards including the Order of Military Medical Merit; Distinguished Service Medal, USUHS; National League for Nursing Council for Nursing Centers, First Public Policy Award; Sigma Theta Tau, Inc., International Honor Society of Nursing, First Public Service Award; Ruth Knee/Milton Wittman Award for Outstanding Achievement in Health/Mental Health Policy, NASW; Delta Omega Honor Society Award for Outstanding Alumnus from a School of Public Health; APA Outstanding Lifetime Contributions to Psychology Award; American Psychological Foundation Gold Medal for Lifetime Achievement in the Practice of Psychology; and Distinguished Alumni Award, University of Hawaii. He has been awarded three honorary degrees. He is currently the editor of Psychological Services. He has over 200 publications.