Psychotherapy Bulletin

Psychotherapy Bulletin

“Never Doubt That a Small Group of Thoughtful, Committed Citizens Can Change the World . . .

The very last event which APA President Tony Puente presided over was to personally present the Presidential Citation to former Division 29 President Ron Fox. “On the closing of the American Psychological Association’s 125th anniversary, I, Antonio E. Puente, as President of our venerable society bestow upon Ronald E. Fox this APA Presidential citation on December 31, 2017. From humble beginnings to being President of our great association, Ron Fox has been driven with a vision of making our world a better place through making the profession of psychology a central change agent. His long and illustrious career has spanned several decades and various settings including as a clinician, a professor, and an advocate for the profession of psychology. Starting early in his career, Dr. Fox stood firmly for ethnic-minorities, for women, and for the poor, when such advocacy was considered unimportant.

“Within APA, he has held numerous governance positions from committee member to being President, and a trustee of the Insurance Trust. Dr. Fox has been a pioneer in so many venues that it is impossible to list them all. But here are some important illustrations: key in establishing the APA Practice Directorate, Division 29 (Psychotherapy), Division 55 (Psychopharmacology), and the Association of Psychology Postdoctoral and Internship Centers (APPIC). He advocated in Ohio for the founding of one of the first Doctor of Psychology programs in the U.S. Dr. Fox was instrumental in establishing one of the first psychology licensing boards in the U.S. (Ohio). In addition, he is considered the ‘grandfather’ for prescription authority in psychology.

“Ron Fox has been a calm, steady, and reasoned voice for all of psychology for almost half a century. For his efforts, his resiliency, his vision, and the many results that have made the profession of psychology what it is today, on this last day of APA’s 125th anniversary, let it be known that Ronald E. Fox is presented this APA Presidential Citation.”

Prescriptive Authority (RxP)

From the very beginning, Ron Fox has been a visionary leader in psychology’s quest for prescriptive authority (RxP). Michael Schwarzchild was one of the first colleagues to respond to Ron’s call. Although the State of Connecticut was not initially successful, CPA President Anne Klee reports they have once again returned to this important policy agenda. Former CPA President and RxP committee chair Barbara Bunk: “I am writing with surprising but good news re the RxP effort in Connecticut. Our Department of Public Health (DPH) has recently informed CPA that our request for review of our scope of practice to include prescriptive authority for appropriately trained psychologists has been accepted. DPH is now forming a Committee to review and evaluate the request, and to make subsequent recommendations to the Public Health Committee of the Connecticut General Assembly for the 2018 Legislative Session. The Committee is comprised of the six healthcare organizations that submitted impact statements regarding our request; each organization gets two seats on the Committee, as do we (CPA). Notably, the Connecticut Psychiatric Society did not appropriately submit, though the DPH Commissioner can indeed appoint additional Committee members if he so chooses – which he subsequently decided to do.

“The six organizations were CTAPRNS – Connecticut Advanced Practice Nurse Society; CCACP – Connecticut Council of Child and Adolescent Psychiatry; CCAAP – Connecticut Chapter American Association of Pediatrics; CHA – Connecticut Hospital Association; CNA – Connecticut Nurses’ Association; and CSMS – Connecticut State Medical Society. The Committee is scheduled to convene two or three times after Thanksgiving.” Anne: “CPA has now had three review meetings with our DPH. At the table were various medical groups. As expected, they brought up issues of quality and safety. They made mention to an article about psychologists not prescribing with the underserved as expected in New Mexico. We are well represented by Barbara, Sharif Okasha, and David Greenfield. Sharif spoke directly to the underlying issue of access. He and his father operate an established mental health practice in the New London region. For two years they have attempted (unsuccessfully) to recruit a psychiatrist or advanced practice nurse to join their practice. On a personal level, he is very interested in pursuing his masters in psychopharmacology in order to continue working with an underserved area of the state.”

The States of Hawaii and Oregon have the unique experience of having their earlier RxP legislation vetoed by their Governors. This year Mental Health America of Hawaii listed Prescriptive Authority for Advanced Trained Medical Psychologists (RxP) as its first Access To Care Advocacy Priority. Kelly Harnick, HPA RxP Chair: “Hawaii is determined. Fortitude and an unwavering commitment best describes the nature of our RxP Committee. The Aloha State truly is filled with Aloha in our hearts for our communities. In Maui country, which includes the islands of Maui, Molokai, and Lana’i, we have an estimated 41-43% psychiatrist shortage. This is unacceptable for our communities that need access to care. RxP was re-invigorated in 2015 when the previous Speaker of the House introduced House Bill 1072, after two community advocates and myself met with him in a little coffee shop in Central Maui. Amazing how an entire movement can ignite over a cup of coffee. At first, being very green at advocacy, I was shocked that the Speaker even agreed to meet with us. Politics occurred and our beloved HB 1072 made it through every hurdle until the last 30 seconds of the legislative session of 2016. Today, we soldier on. We now have HB 2734 introduced yesterday by the Health and Human Services Chair, Rep. Mizuno. Our goal is steadfast, and I am beyond grateful for my Committee and their dedication to getting RxP passed for our patients.

“Hawaii is obviously a bit different than other states because we are an island state. If you live on a neighbor island you can’t just drive to the big city, you have to take a flight. This means that if you need care that is unavailable, you have to somehow find a way to fly over to Honolulu in order to get the care you need. As the RxP Chair living on Maui, this is unacceptable for our community. The legislature opened last week Wednesday, and we are going to work harder than ever before to finally get the RxP bill passed for the people of Hawaii.

“To get a bill passed, it is very important to understand the parliamentary procedures in your state legislature. It is also very important to empower the people on your committee that are looking up to you for leadership. It can feel quite pressured because when it comes down to it, you know that you are responsible for advocating for a bill that could save lives. As the RxP Chair, I always remind myself when it’s very easy to get wrapped up in the noise of politics and power, why we are doing this in the first place -- because there are people suffering, going without care. Our suicide rates are amongst the highest in the country. Most people would be shocked by learning that. A common myth is that we simply live in paradise so what is there to be depressed about? However, psychopathology such as clinical depression, bipolar disorders, anxiety disorders, and PTSD to name a few, don’t discriminate even if coconut Palm trees are swaying in the trade winds. The people of Hawaii are not immune to needing both integrated psychological and psychopharmacological care because they live in ‘paradise.’

“Prescribing Medical Psychologists have a value system and clinical approach that the patients are absolutely yearning for: to work with a Doctor who knows them well while engaging in therapy, as well as one who encompasses the medical expertise being able to prescribe medication safely, as well as taper them off medication. One of the myths and arguments of the opposition that bothers me the most is that RxP is about wanting to prescribe more pills. It simply is not!

“As a psychologist, our training is very special. We not only are astute on understanding the therapeutic relationship and the healing power it has; but also therapists with the additional medical knowledge that a prescribing medical psychologist has. I believe it intimidates the opposition because patients want this kind of treatment from a Doctor they feel truly cares and actually knows them well. Here in Hawaii, we are now beginning to gear up again, working towards getting this RxP bill through the legislature for yet another time, and as we’ve heard many times before “If we don’t stop we will win” [Louisiana’s Jim Quillin]. Hawaii will not stop and we will win for our very special island communities. As the RxP Chair, I personally will not stop and I feel grateful to have a Committee that is as dedicated as any Chair could ask for.”

Investing in Our Future

I have just completed two terms of service on the Board on Children, Youth, and Families of the National Academy of Medicine (NAM). This has been an exhilarating experience, working with dedicated colleagues from a broad range of disciplines, addressing issues directly impacting the wellbeing of our nation’s children and their families. Many of these are fundamental to President Obama’s landmark Patient Protection and Affordable Care Act, with its emphasis upon prevention, wellness, and population-oriented approaches to healthcare. According, it was perhaps surprising to realize, in retrospect, that many of the absolutely critical issues raised during these discussions are ones that previously I only might have superficially contemplated – emphasizing the intellectual limitation of working within comfortable, although isolated, “professional silos.” Psychology is especially fortunate that former APA Congressional Fellow Natacha Blain currently serves as Director for the Board, having recently taken over from another visionary psychologist Kimber Bogard.

Last year the Board, under the auspices of the National Academies of Science, Engineering, and Medicine, released its consensus study report, Promoting the Educational Success of Children and Youth Learning English. A long-time friend and colleague, Ruby Takanishi, served as Chair of that Committee. Ruby was formally President and CEO of the Foundation for Child Development. She has also served as Director of the APA Office of Scientific Affairs, as well as Executive Director of the Carnegie Council on Adolescent Development. Highlights:

Educating Dual language learners and English learners effectively is a national challenge with consequences both for individuals and for American society. Despite their linguistic, cognitive, and social potential, many English learners—who account for more than 9% of enrollment in grades K-12—are struggling to meet the requirements for academic success, and their prospects for success in post-secondary education and in the workforce are jeopardized as a result. A defining characteristic of these two groups is their demographic diversity. They are members of every major racial/ethnic group and include both youth born in the U.S. and internationally. Most come from Latin America and Asia, with Mexico being the leading country of origin. Relative to other U.S. children, they are far more likely to live in poverty and in two-parent families with low levels of education. Nevertheless, those that become proficient in both a home or primary language and English are likely to reap benefits in cognitive, social, and emotional development and may also be protected from brain decline at older ages. In addition, the cultures, languages, and experiences of English learners are highly diverse and constitute assets for their development, as well as for the nation.

Both society at large and many educational and health professionals hold competing views about whether dual language learning should be supported early in a child’s development and later in school. Some believe that learning two languages early in life is burdensome, while others believe that young children are “hardwired” to learn one or more languages easily and that nothing needs to be done to promote their language development. Scientific evidence clearly points to a universal, underlying human capacity to learn two languages as easily as one, and the available evidence is mixed as to whether there is a critical period for learning a second language. Research shows that it can take from five to seven years for students to learn the English necessary for participation in a school’s curriculum without further linguistic support. Native language revitalization is an urgent matter for Native American communities. Some, however, unfortunately see this as being in direct conflict with school’s efforts to promote English language learning.

It is important to appreciate the long-term consequences for the nation of the reality that a high educational achievement and attainment gap exists between English language learners and their monolingual peers. For example, the reading achievement gap is 36 points at the 4th -grade level and 44 points at the 8th -grade level. The high school graduation rate comparison is 63%—far lower than the rate for students living in low-income families at 75%—and the overall national rate of 82%. Language lies at the center of all human development!

Never forget, as this Column’s title reminds us: In the words of Margaret Mead: “ . . . Indeed, it’s the only thing that ever has.”

Aloha.

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Cite This Article

DeLeon, P. (2018). “Never doubt that a small group of thoughtful, committed citizens can change the world . . . ” Psychotherapy Bulletin, 53(1), 55-58.

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