Since having retired from the U.S. Senate staff after 38+ years, I have had the very rewarding opportunity to be actively engaged with the graduate students at the Uniformed Services University (USU), thereby experiencing higher education from an entirely different vantagepoint. Our colleagues in the health professions represent society’s educated elite. Accordingly, we have a unique societal obligation to provide visionary leadership in addressing our nation’s most pressing needs. Our collective experience with today’s COVID-19 pandemic should bring this readily home to every one of us. How could so many of our nation’s children face food insecurity? The United States is one of the richest nations in the world. And yet, in 2015, more than 9.6 million children lived in families with annual incomes below the poverty line, with approximately 2.1 million living in “deep poverty.” Not surprisingly, the highest rates of poverty were found among Hispanic, African American, and American Indian/Alaskan Native families. This should be deeply concerning to all of us as the science makes clear that poverty during pregnancy and childhood is directly tied to poor health and developmental outcomes, thus significantly contributing to health disparities which are all too evident.

The Public Policy Process

From our perspective, education and having caring role models are the key to a healthy society. At USU, we have been pleased to be able to coordinate a small, interactive Public Policy seminar every semester, targeting the students and faculty from psychology and the Daniel K. Inouye Graduate School of Nursing (GSN). Our goal has been to expose these future leaders to the personal stories of outstanding role models who have gone before them. An unanticipated benefit of the pandemic has been our ability to conduct the seminar in a virtual format, utilizing Zoom technology, and thus capitalizing upon a significantly wider range of guest speakers and attendees. This semester we were able to have a former Secretary of the Department of Veterans Affairs (VA), former APA President, Phil Zimbardo; and one of the founding champions of the field of Health Psychology, Margaret Chesney. Later on, we expect to hear from Shawnna Chee, the psychologist serving on the US Comfort as it served those directly impacted by the pandemic. Throughout the speakers’ journeys, several reoccurring themes become evident. For example, one really cannot control the specifics of how one’s professional future might evolve – unexpected opportunities frequently arise for those with vision; one’s environment is critical; and, persistence, being present, and possessing resilience makes a significant difference.

Christy Anne Velasquez (Major, USAF, NC): As a graduate student at the USU Graduate School of Nursing, I have the opportunity to be a teaching assistant for our Public Policy seminar, learning about diverse health topics and professions, to include nursing, psychologists and physicians.  Each guest speaker has helped me understand the different roles, contributions, and challenges of their profession. Our recent prominent speaker, distinguished social psychologist Philip Zimbardo, joined our seminar with a groundbreaking attendance from across the country. His seminar was an hour-long open forum where faculty, students and guests discussed the importance of his works (such as Discovering Psychology and the Stanford Prisoner Experiment), and asked compelling questions about past works, his current effort with the Heroic Imagination Project, and his perspective on current national events. This engaging and enlightening experience taught me the value of his contributions to psychology, as well as the importance of critical and systematic thinking and remaining resilient during challenging times. We all want to thrive today and the day after and we must continue asking ourselves ‘how,’ ‘what,’ ‘why,’ and ‘how can we solve this problem as heroes.’ That is what critical thinking will do for us now and for the future.

Victoria Philippon, M.S. (PhD student, University of Central Arkansas): When I was completing my undergraduate studies, I was first introduced to Phil Zimbardo in my Introduction to Psychology course. I was excited to learn more about his research, including his focus on heroic behaviors. My research interest includes re-entry and reintegration for criminal justice involved populations, specifically strengths-based approaches to address these areas. The information discussed, I believe, could inform future work with criminal justice involved populations in an effort to support them after they are released and prevent them from becoming negatively involved with the system to begin with.

I attended Margaret Chesney’s presentation as she discussed the unique obstacles she overcame as a woman in psychology. As a female professional myself, I found it particularly inspiring to engage with someone who has broken the glass ceiling and helped made my presence a possibility. She applied to PhD programs when women were not given opportunities to attend and doors were closed due to sexism. I was truly inspired and encouraged by what she overcame and all she has accomplished. Her presentation was also informative as she is one of the top scholars in the field of integrative medicine, having served as the Deputy Director of the National Institutes of Health’s Center for Complementary and Integrative Health. She discussed the cost of pain to society during her presentation, reporting that billions of dollars, between $560-$630 billion, are spent nationally in pain management efforts each year. With pain being one of the biggest instigators for people to explore integrative healthcare approaches, one would expect the immense cost to decrease with the utilization of alternative, nonpharmacological approaches. I was especially interested in her desire to promote health and well-being as it reflects my strengths-based approach. I am interested in applying such a strengths-based approach to justice-involved persons. Each week, the speakers constantly open my eyes to new impacts of health policy on society, as well as on healthcare professionals.”  Near the end of our session, the grandfather of Health Psychology, former APA President Joe Matarazzo joined us.  Joe (who was on the inaugural USU Board of Regents) and David Krantz, former President of Division 38 (Health Psychology) and former Chair of the Department of Medical and Clinical Psychology at USU, provided engaging insights into the creation and development of the field and the university over the decades.

Nurse Managed Health Care

Tine Hansen-Turton is a long-time colleague who served as the Executive Director of the National Nursing Centers Consortium for 18 years. She then moved to the front-line, where for the past four years, she has served as CEO for Woods Services. For over 25 years, Tine has worked to promote nurse-led care, having founded two national organizations advancing nurse practitioners as primary care providers and advocating for scope of practice policy changes for nurse practitioners nationally. Interestingly, Woods established a Nursing Fellows Program two years ago, which has been held for two cycles with 11 Fellows, four of whom have since entered BSN, Master’s, or Doctoral programs in nursing with partial scholarship support from Woods, and moved into advancing leadership roles.

Woods Services is a 501(c)(3) non-profit population health management and advocacy organization that along with its five affiliate organizations provides innovative, comprehensive and integrated health, education, housing, workforce, behavioral health and care coordination services to 18,000 children and adults with intellectual and developmental disability, autism, severe behavioral challenges, mental health disorders, and brain injury who have complex medical and behavioral health care needs.

Nurses have always been the backbone of care for the 700 children and adults with intellectual disabilities requiring complex care who Woods serves at its main location in Langhorne, PA.  However, the team of nurses, 70 strong, has transformed along with the rest of Woods along its trajectory to becoming a population health organization. The approach to care delivered by nurses lends itself well to the integrated and interdisciplinary health care model which Woods has developed over the last several years. Nurses have emerged as leaders at Woods.

The role of nurses at Woods is critical, given their focus on holistic patient care, education, and care coordination. Furthermore, integrated care at Woods means interdisciplinary team-based care, including nurse-led primary care, nurse-led psychiatry, neurology, dentistry, orthopedics, ophthalmology, radiology, and nursing. In addition, health services are coordinated by nurse navigators, a new role for us as of this year, with the allied health team – physical, occupational, and speech therapists. Bringing on both family nurse practitioners and psychiatric nurse practitioners at the Medical Center at Woods, which serves as the umbrella for our health care services, has been a game-changer. Two years ago, Woods, in partnership with Pennsylvania’s largest Medicaid insurer, launched a Patient-Centered Medical Home initiative with the goal of improving care and reducing emergency room (ER) visits and hospitalizations – and with it the cost of care.  Our results after one year were promising – hospitalizations alone were reduced 39%.  Primary care visits were increased and care coordination improved. The team of nurse managers also provided education and training for the nearest ER, which had two positive results. First, because of increased knowledge about the special needs of the complex population we serve, ER visits less frequently resulted in hospitalizations. Second, the ER has created a sensory-friendly waiting room for patients with autism, reducing anxiety, stress and negative behavior. We seek to build on these promising results by expanding our expertise through nurse-led telehealth to people with intellectual disabilities who reside in group homes or with family caregivers who struggle to access care.

Woods is in the process of implementing a nurse-led telehealth program to provide primary and specialty care for people with intellectual disabilities and autism who continue to be an underserved population, and who experience barriers to care and significant health disparities.  The telehealth program will expand our Patient-Centered Medical Home model, initially reaching 750 people with complex needs who we and our affiliates currently serve in Greater Philadelphia. This model is rooted in tenets common to the holistic nature of nursing – a focus on the whole person, patient education, and care coordination. Our strong team of 70 nurses and nurse practitioners are well positioned to carry out this program. More than eight million people in the United States have an intellectual disability, and 35% of this population has co-occurring mental health disorders, which put them at even greater risk of poor health outcomes. With the rapidly increasing rates of autism spectrum disorder diagnoses, this is a growing population with some of the greatest unmet health care needs in the country. People with intellectual disorders, autism and complex medical conditions struggle to find providers who will take Medicaid, and who can accommodate communication, behavioral, and mobility needs at their practices.  Woods’ nurse-led telehealth initiative will be sustainable, and has the potential to scale up to reach a large vulnerable population, including rural residents, which disproportionately uses the ER and is often left out of mainstream services.

Recalling the Past

VA Psychology historian, Rod Baker, shares my enthusiasm for ensuring that our next generation of healthcare leaders appreciate the historical efforts of those that came before them.  Accordingly, we were very pleased to learn that our longtime colleagues Ron Breazeale and Jeff Matranga have recently published DIRIGO: MePA AND ITS PRESIDENTS on the 70^th Anniversary of the founding of the Maine Psychological Association, as reflected in the lives of its Presidents.  “Our Presidents are a relatively diverse lot. Most are “from away.”  Our first President, Dr. Norman Munn, surely fits that description. He was from Australia; after spending many years in the US lecturing, teaching, and writing, he returned to Australia to retire. But some, like Dr. David Booth, were born, educated, and lived out their lives in Maine. Now we said relatively diverse. To our knowledge, a person of color has never been President of the Association, and it was not until 1989 when the first woman [Anne L. Hess, PhD] was elected President. Since that time, eight more women have served in that role.”

“All things must pass.” – George Harrison

Aloha,
Pat DeLeon, former APA President – Division 29 – October, 2020

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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.