“IF YOU PLAY IT SAFE IN LIFE”
A National Vision: In December, 2013, following the service of Chairman Ron Rozensky, I was very fortunate to be appointed by Health and Human Services (HHS) Secretary Kathleen Sebelius to her Advisory Committee on Interdisciplinary, Community-Based Linkages (ACICBL), which provides policy and program development guidance for a number of the health professions training programs administered by the Health Resources and Services Administration (HRSA). During his term as Chair of ACICBL, Ron noted that they co-signed a letter to Congress supporting the inclusion of funding for interprofessional healthcare in the Affordable Care Act (ACA) and their Annual Report to Congress stressed the importance of behavioral health integrated care. “Having psychologists on this key federal advisory committee is an important mechanism that supports our voice being in the room when critical policy for tomorrow’s interprofessional healthcare systems is being crafted.” This August, ACICBL issued its 15th Annual Report to the Secretary and the U.S. Congress. My term has now concluded; however, I am confident that rural America, our nation’s Native Americans, and psychology will be well represented by Jacqueline Gray who will continue to serve on ACICBL.
“The United States healthcare system strives to deliver safe and effective care, while also promoting innovations in procedures, medications, and technology. Despite its strengths, the system is expensive and inefficient. As a result, the health status of the U.S. population lags behind that of many other developed countries. Furthermore, the system must now respond to changing conditions, including an aging population, an increase in chronic health conditions, and ongoing disparities in health outcomes that show the benefits of the healthcare system are not accessible to all. There is a greater emphasis on primary and preventive care, along with a shift toward value-based services.
“These changes impact the healthcare workforce. However, this workforce faces several challenges, including a shortage of qualified practitioners, poor geographic distribution of practitioners that limits access to services, and an increasing average age of both current practitioners and the faculty who teach new students. Meanwhile, healthcare organizations are transitioning toward an interprofessional team-based model of care, in which traditional health professionals work alongside community health workers or other providers, bringing together complementary skills toward the goal of improving patient care. All of these factors point to an urgent need to adjust health policies, develop new methods of education, and increase investment in healthcare workforce training to promote interprofessional education and practice.
“There has also been increasing discussion on improving training methods. Traditional training criteria involve the completion of a set number of training hours or types of care experiences. However, educators in many professions are examining models in which students must demonstrate their competence in fundamental skills, knowledge, and attitudes to become certified to practice. This competency-based training allows for greater individualization in the design and evaluation of learning experiences (ACICBL, 2017).”
The report further notes that the nation’s healthcare system has traditionally focused on providing acute care within a hospital or similar clinical setting. The aim of this approach is to preserve or restore health in the event of an illness or injury. Acute care is, by definition, episodic and tends to treat only the current problem. As such, it tends to be uncoordinated, inefficient, and expensive, often failing to address underlying health conditions or to help patients reduce preventable health risks. In sharp contrast, the healthcare envisioned by President Obama’s ACA, as well as the “Triple Aim” proposed by the former Administrator of the Centers for Medicare and Medicaid Services (CMS) Donald Berwick, emphasizes improving the experience of care, improving the health of populations, and reducing per capita costs simultaneously. To succeed in this transformation, there must be a conscious shift away from traditional professional educational “silos” and equally importantly, developing respect by the next generation of practitioners for each profession’s unique perspective. To accomplish these goals, training for students in the health professions will need to incorporate the value of teamwork and include collaborative experiences with other health professionals. This visionary approach represents a fundamental, if not unprecedented, shift in orientation from the status quo.
APA Education Directorate’s Catherine Grus: “Interprofessional training experiences should be provided to health professions students early in their training to help mitigate the formation of professional stereotypes and continue on through their clinical rotations. It is equally important to provide opportunities for practicing health professionals to enhance their skills in interprofessional collaborative practice so that when the next generation enters the healthcare workforce they will have role models.”
Not surprisingly, ACICBL’s first Policy Recommendation is: “Congress revise the eligibility requirements for Title VII, Part D, programs. Eligibility should not be limited to specific health professions schools in isolation. To promote interprofessional education, applicants should be permitted to develop the strongest consortia available to them, based on their access to local health professions schools, the strength of available partners, and the needs of the community.”
In a recent “letter to the editor” for a nursing journal, a director of a Nurse Practitioner program commented: “To me, the overarching health care system is like an umbrella with the different spokes representing various disciplines such as Psychology, Nursing, Social Work, Medicine, Therapies (physical, occ, rehab), Nutrition, etc. The handle is held by and belongs to the patient as ‘captain of the ship.’ After all, whose life is it anyway?” She went on to comment on the number of times the term “medical” was used when instead should have been “health.” “I don’t think nursing will be recognized as an autonomous profession until the word ‘health’ is substituted for ‘medicine’”.
The Illinois Vision: “With the passage by both Houses of the Illinois State Legislature of Senate Bill #2187 on May 29th and 30th of 2014, and the signature of then-Governor Pat Quinn on June 25, 2014, the Clinical Psychologist Licensing Act was expanded to give licensed clinical psychologists, with advanced, specialized training in Clinical Psychopharmacology and Medicine, the opportunity to apply to the Illinois Department of Financial and Professional Regulation for licensure as a ‘prescribing psychologist.’ Our legislation served as a signal that Illinois was interested in repairing a broken healthcare system. The new statute opened up access to mental health care for the most poorly served citizens throughout our state.
“The passage of an RxP law significantly advanced the field of psychology, as we become only the fourth state (after Indiana, New Mexico and Louisiana), and the first northern, industrial state, in the nation to pass a prescriptive authority statute. While Guam passed its RxP legislation in 1998, it is a U.S. Territory. Iowa (2016) and Idaho (2017) quickly followed Illinois’ passage. Uniquely, in Illinois, licensed clinical psychologists, as well as psychology graduate and undergraduate students, can embark on their studies to become prescribing psychologists. The Illinois law contains three levels of required training: * seven undergraduate basic science courses; * the Master’s in Clinical Psychopharmacology with the capstone Psychopharmacology Exam for Psychologists-2 (PEP-2); and, * a series of rotations through nine medical specialties over a period of 14 months (minimum) – 28 months (maximum).
“With the hard work and persistence of IPA leadership, staff, and a vigorous and ever-growing group of dedicated IPA members, as well as the persistence of our lobbyists, administrative attorneys, and state legislative champions (Senator President Pro-Tem, Don Harmon, in particular), the final rules for the RxP law were approved on September 12, 2017 – more than three years after SB #2187 was signed into law.
“After spending these years implementing the tenets of our legislation, I like to say that Illinois RxP is currently in its ‘toddler’ stage. There are more than 150 Illinois licensed clinical psychologists who are currently studying to become licensed prescribing psychologists. Of those 150, at least 25 have completed their Master’s degrees in Clinical Psychopharmacology as well as their required series of seven undergraduate basic science courses; have taken their capstone exam (PEP); and are now poised to enter their medical rotations. In addition, there are 75 undergraduate psychology majors at the largest state University, the University of Illinois, Champaign-Urbana, who have chosen the ‘pre-prescribing psychology’ concentration, which adds the seven statute-required basic science classes to their traditional undergraduate psychology curriculum. Major medical center and hospital systems, as well as local community hospitals, are working with us to provide the required rotation opportunities.
“As we approach 2021, Illinois psychologists and our many third party supporters (medical center CEO’s, psychiatric medical directors, social service organizations, elder care agencies, primary care physicians) will be preparing to go back to our state legislature to lobby for the removal of some of our initial statutory constraints. Like nurse practitioners, physician assistants, and optometrists before us, the plan is for us to continue to return to the state legislature every five years until we can practice without statutory constraint.
“There is palpable excitement among our psychologist colleagues. We have a vision of a future in which our training, our experience, and our comprehensive competencies will give us the opportunity to meet the mental and behavioral health needs of so many of our community’s most underserved populations. Our expertise is already in great demand. Meeting that demand will give us tremendous personal and professional satisfaction (Beth Rom-Rymer).” “You’ve decided that you don’t want to grow anymore.” Aloha,
Pat DeLeon, former APA President – Division 55 – October, 2017