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  • October 10, 2017 9:54 AM | Kelly Wetzel (Administrator)

    California Psychological Association publishes aid-in-dying resource for psychologists

    California’s End of Life Option Act indicates important roles for psychologists.


    By Hannah Calkins

    The Council of Representatives recently reaffirmed APA’s neutral stance on physician aid-in-dying. But in states where the practice is legal, psychologists may be asked to assess terminally ill patients pursuing this option, or to counsel patients and their families about it.

    California is one such state. This summer, the California Psychological Association (CPA) released a 15-page documentcontaining information and guidance for psychologists who provide, or are considering providing, services related to the state’s End of Life Option Act (ELOA). The law, which went into effect in June 2016, allows terminally ill adults in California to obtain aid-in-dying drugs from physicians if they meet certain requirements and follow specific procedures.

    As with similar laws in other jurisdictions, one of the ELOA’s requirements is that patients requesting aid-in-dying drugs have the capacity to make medical decisions and not be suffering from impaired judgment due to a mental disorder. If there are indications of a mental disorder, the patient must be referred to a psychologist or a psychiatrist for an assessment.

    However, the law does not offer details on how these assessments should be conducted, nor does it address related services that psychologists may be asked to provide, such as counseling patients and their families about end-of-life options, said Elizabeth Winkelman, JD, PhD, CPA’s director of professional affairs.

    “CPA felt it would be useful to develop a guidance document that addresses ethical and professional practice considerations in this area more broadly, in addition to explaining the requirements of the ELOA,” said Winkelman, who also chaired the work group that authored the document.

    She noted that the document is designed to be educational and to encourage a thoughtful, thorough approach to end-of-life options, and is not intended to set mandatory guidelines or a standard of care.

    Regardless of psychologists’ personal views on physician aid-in-dying, Winkelman said, it’s helpful for them to understand the issues involved in the practice, since they may be asked about it by patients and their families or by colleagues.

    “Psychologists can contribute meaningfully in this area as experts in mental health care, psychosocial and cultural issues and assessment,” she said.

    Education and sharing across states

    California is one of seven jurisdictions in the United States to authorize physician aid-in-dying, including OregonWashington stateVermont (PDF, 34KB), Colorado (PDF, 632KB) and Washington, D.C. (PDF, 9.67MB) (The seventh, Montana, is unique and technical; it authorized physician aid-in-dying through a judicial decision, and there is no law governing the practice there.) The laws are similar, and all identify the same key roles for psychologists and psychiatrists.

    The Washington State Psychological Association (WSPA) produced a document similar to CPA’s (PDF, 155KB) in 2009, the same year that the Washington Death with Dignity Act went into effect, said Alison Ward, PhD, the facilitator of WSPA's Palliative Care and End of Life Special Interest Group.

    This document is currently being revised, and WSPA plans to release an updated version later this year. “We hope to educate psychologists and other mental health professionals on palliative and end of life care, and to provide guidance and support to those who are interested in conducting these evaluations,” Ward said.

    Winkelman said that WSPA’s 2009 guidelines were a great resource for CPA’s work group, and likewise, she hopes that CPA’s guidance document will be helpful to others.

    “Many of the issues psychologists face will be the same, regardless of the state in which they are practicing,” she said. “CPA hopes this guidance will be useful to psychologists outside of California and to other state psychological associations.”

  • October 02, 2017 12:38 PM | Kelly Wetzel (Administrator)

    INTRIGUING ISSUES TO BE ADDRESSED

    September is Suicide Prevention Month.  All of our State Psychological Associations have members who currently serve in the military, are Veterans, or members of military families.  VA Secretary David Shulkin: “We know that in 2014, an average of 20 Veterans a day died in this country from suicide, which is 20 too many.  This is a national public health crisis requiring a national public health approach.  When it comes to preventing Veteran suicide, VA can’t – and should not – do this alone.”  In 2005, over 12 years ago, Psychologist Barbara Van Dahlen founded Give an Hour which has since provided free mental health care to those who serve, our Veterans, and their families.  Collectively, generous volunteer mental health professionals have donated over 124,000 hours of free care and support, valued at nearly $23 million.  Most recently, this impressive organization has partnered with the Red Cross to respond to the unprecedented devastation on the Gulf Coast as a result of Hurricane Harvey and Irma.  Their model has been proven and is being expanded to now address the mental health concerns of other populations in need -- including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.  Has your State Association partnered with Give an Hour and more importantly, have you volunteered?

    Scope of Practice Issues -- The Times They Are A-Changin’:  Those who attended the exciting 125th annual APA Convention may have been exposed to several far reaching policy discussions (including on the floor of Council) regarding telehealth and what psychology’s position should be on the increasingly expanding role of master’s trained mental health clinicians.  Members of the Education and Practice Directorate and the Board of Directors coordinated a recent Masters Summit, sponsored by the APA Minority Fellowship Program, during which 32 members of the APA governance actively participated.  Those in attendance represented practice, education and training, public and private sector psychology, the VA and other hospital settings; as well as additional identifiable stakeholders, including other disciplines.  President Tony Puente’s overview: “The Council addressed a complicated issue that has eluded successful resolution by the discipline of psychology over more than 70 years, agreeing by acclamation that ‘current issues and developments have risen to the level that APA should take a position on master’s level training and/or practice….’  Further action is expected on this issue in February.”

    From a broader policy perspective, 22 states and the District of Columbia now have enacted full practice authority for their advanced practice nurses.  Pursuant to Congressional direction, in the near future, the Departments of Defense and Veterans Affairs will be exploring the training and utilization of Physician Assistants (PAs), specially trained in mental health.  Those colleagues working within integrated care models, especially where visionary leaders from Colleges of Pharmacy have been involved, will appreciate that there are an increasing number of Clinical Pharmacists who are specializing in the appropriate utilization of psychotropic medications, as well as the psychosocial-economic-cultural gradient of “quality care.”  Addressing efforts to “repeal and replace Obamacare,” the former White House Director of Economic Policy under President George H.W. Bush recently proffered: “State governments should give greater authority to nurse practitioners and physician assistants to open their own practices and encourage walk-in clinics.”  Has your State Association partnered with your local State Pharmacy, Nursing, or Physician Assistant Associations in developing joint CE programming?  “The future ain’t what it used to be.”  Aloha,

    Pat DeLeon, former APA President – Division 31 – September, 2017

  • August 31, 2017 4:54 PM | Kelly Wetzel (Administrator)

    Exciting Times:  Ever since graduate school, I have always felt that attending the annual APA convention was “my gift to me.”  It represents a time to reunite with colleagues that I have not seen in a while and at the same time, actually learn quite a bit about the advances occurring within psychology.  At its conclusion, I always feel exhausted and yet emotionally recharged.  These interpersonal interactions reaffirm why I chose psychology decades ago.  We can make a significant difference in the lives of our nation’s citizens.  This year was no exception with 12,000 in attendance, including the Presidents of 26 national psychological associations.  I was especially impressed with the enthusiasm and dedication expressed by psychology’s next generation of graduate students and early career psychologists.

    President Tony Puente’s programmatic initiative “Past Presidents Unscripted” provided an opportunity to reflect; it was very enjoyable and well received by the membership.  Tony’s open invitation to the membership to visit the Smithsonian National Museum of American History was fascinating – especially seeing the Star-Spangled Banner flag which flew over Fort McHenry and inspired Francis Scott Key to write what would become our national anthem.  Not surprisingly, those programs addressing telehealth and the increasingly sophisticated clinical utilization of apps were standing room only.

    Several panels on which Linda Campbell, Fred Millan, Jana Martin, and Deborah Baker participated took the unique approach of having all of their speakers address a common vignette, with active audience participation.  The application of the Telepsychology Guidelines through vignettes brought home the complexities and yet the basic ethical standards that apply to telepsychology just as they do to in-person services.  The fact that there was standing room only supports the notion that telepsychology is a cutting edge aspect of psychological practice.

    On a personal level, I was particularly pleased to learn of APA’s renewed interest in addressing the master’s issue – an admittedly highly complex and controversial topic which several colleagues, members of the Board of Directors and I, during my APA Presidency in 2000, attempted to resolve – without any meaningful success.  Members of the Education and Practice Directorate and the current Board of Directors coordinated a recent Masters Summit which was sponsored by the APA Minority Fellowship Program and its director Andrew Austin-Dailey, during which 32 members of the APA governance actively participated.  Those in attendance represented practice, education and training, public and private sector psychology, the VA and other hospital settings, as well as additional identifiable stakeholders.  There was representation from several other disciplines, as well as a master’s accreditation organization.  The APA Council of Representatives, Council Leadership Team, Board of Directors, and other governance groups will consider and deliberate in due course on further potential action.  The report on the summit can be found on the APA Website.  Tony’s summary: “The Council addressed a complicated issue that has eluded successful resolution by the discipline of psychology over more than 70 years, agreeing by acclamation that ‘current issues and developments have risen to the level that APA should take a position on master’s level training and/or practice….  Council directs staff and governance to identify and explore options for APA to pursue.’  Further action is expected on this issue in February.”

    In my judgment, this particular development is extraordinarily important, especially with the nation’s steady evolution towards interdisciplinary, team-based health care, in which psychological and behavioral health services will be increasingly integrated into primary care.  Psychology is one of the bona fide health care professions.  We must provide visionary leadership to effectively address the access and quality health care needs of our nation.

                The Nation’s Evolving Health Care Environment:  It is critically important for psychology to appreciate that no profession lives or practices in an isolated environment.  A recently published nursing journal noted: “It appears that the tipping point for barriers to nurse practitioner (NP) practice is either here or imminent, given that 22 states and the District of Columbia now have full practice authority.”  The author further urged her profession to understand that in drafting legislation, NPs need to include the authority to do things other than prescribe.  They need authorization to make medical diagnoses, order tests and therapies, perform procedures needed in primary care or acute care, as well as prescribe.

    The Department of Veterans Affairs (VA) is the largest employer of nurses and it is also the largest employer and trainer of psychologists.  Under the leadership of Secretary David Shulkin, the VA has now adopted a national scope of practice for its nurses providing full practice authority for advanced practice registered nurses (APRNs) (with the exception of nurse anesthetists), as long as they are working within the scope of their VA employment.  APRNs can provide care, regardless of historical state or local legal restrictions, without the clinical oversight of a physician.  This includes taking comprehensive histories, providing physical examinations; and diagnosing, treating, and managing patients with acute and chronic illnesses and diseases.  It allows VA APRNs to prescribe medications and make appropriate referrals.

    Under the Secretary’s leadership, the VA announced five top priorities which included Suicide Prevention – Getting to Zero (sadly, from 20 daily).  The number two priority was Improving Timeliness, highlighting the potential for telehealth.  The Department reported having established 10 Tele-Mental health hubs and eight Tele-Primary Care hubs.  During the APA pre-convention period, the Association of VA Psychology Leaders (AVAPL), under the stewardship of Russell Lemle, actively addressed these issues and psychology’s contributions.

                Similarly, U.S. Army Surgeon General Nadja West, the highest ranking woman to graduate from the U.S. Military Academy, is actively attempting to reshape military health care delivery by creating a culture of innovation and shifting the historical mindset that treatment can only be provided in a clinic.  Two of her expressed top priorities are: * Better access to behavioral health -- embedded behavioral health specialists and more virtual appointments to make it easier for soldiers and their families to get needed care more quickly and discreetly.  And, * Telehealth -- virtual medical appointments becoming more commonplace as the Army ramps up its ability to deliver care at home with new equipment and training for care givers.  Her underlying goal is building a “premier, expeditionary, globally integrated medical force.”

                With the ever-changing federal health delivery environment as background, one of the most exciting convention events was the informal gathering of those passionately interested in the prescriptive authority (RxP) agenda.  Beth Rom-Rymer: “On Saturday of the convention, Bob Ax and I chaired a meeting of like-minded psychologists in the Division 18 (Public Service) suite to discuss the rationale for graduate students to take a joint degree in Clinical Psychopharmacology, in conjunction with their doctoral degree in psychology, as they prepare for becoming licensed prescribing psychologists as well as licensed clinical psychologists.  The key components of the rationale are that, by studying Clinical Psychopharmacology in graduate school: * Students will be better able to integrate all components of their training – the basic sciences; the traditional psychology course curriculum; and the biological, chemical, and neurological processes by which psychotropic medications can support the cognitive and emotional learning that takes place during psychotherapy.  * A greater number of trainees can enroll in the Clinical Psychopharmacology training as graduate students, at the point that they begin to shape their careers, rather than as licensed, practicing, clinical psychologists who face the steep challenge of ‘returning to school’ after having already received the doctorate degree.  And, * Access to care will become significantly improved, thus better serving the public, as the numbers of prescribing psychologists will multiplicatively increase with graduate students taking the opportunity to earn the joint degrees.

                “Lenore Walker offered positive data from the training program at NOVA Southeastern University.  For five years, NOVA trained graduate students as well as licensed, practicing psychologists and found few differences in achievement between the two groups.  The largest difference, perhaps, was that the graduate students often scored more highly on the class exams.  Moreover, NOVA has learned the graduate students who are now licensed clinical psychologists are effectively using their training in Clinical Psychopharmacology, whether they work in prescribing states or not.  Dean Karen Grosby, of the College of Psychology at NOVA, is looking forward to the day when they will again begin to train graduate students in Clinical Psychopharmacology.

                “Other psychologists discussed the parameters under which graduate students would take the additional training.  It was pointed out that the strongest students would probably be the ones who would be able to manage the joint degree.  In a similar way, we noted that a certain percentage of psychology graduate students already take joint degrees in other fields (nursing, business administration, biology, law, journalism) and, typically, these students carve out interesting and highly successful career paths.

                “APA has just appointed a curriculum committee that will be reviewing the criteria for APA ‘designation’ for training programs in Clinical Psychopharmacology.  Some of our meeting discussants have been appointed to that committee.  In the future, APA may decide to approve training in Clinical Psychopharmacology at the graduate, predoctoral level.  Right now, graduate students in Illinois are preparing to be the first cohort of graduate students, nationally, who will be, indeed, doing the joint degree in Clinical Psychopharmacology at New Mexico State University, in conjunction with their doctoral degrees in universities in Illinois.  I have started a dialogue with out new APA CEO, Arthur Evans, about training at the graduate level.  He hopes to learn more about our Illinois law when he comes to Chicago early in the new year.  Change does not come easily.  Stitch by stitch, we are piecing together an innovative design.  With time and patience, all will come together.”

                Psychology is Critical for Effective Change:  Former APA President Frank Farley (extremely active throughout the convention) has been stressing this message since his involvement in the association’s governance.  Under the leadership of former APA Congressional Science Fellow Natacha Blain, the National Academy of Medicine will be exploring what role technology can play in improving educational outcomes.  In 1984, there was 1 computer per 125 students in the U.S.; in 1998 there was 1 per 7 students; and in 2008 it was 1 per 3.  This does not include home computer use or smart phones.  The potential of information technology as a learning aid is significant.  Computer literacy and fluency are essential life skills in today’s highly technology-reliant society.  However, U.S. high school students consistently rank below average in math and close to average for science and reading in international comparisons.  How can we collectively contribute to this important agenda?  Aloha,

    Pat DeLeon, former APA President – Division 29 – August, 2017

  • June 16, 2017 10:58 AM | Kelly Wetzel (Administrator)

    State Beat: State leaders address letters on 90837 and advocate for testing data

    A legal victory for psychologists in Maine; current procedural terminology code advocacy in Pennsylvania; adding psychologists to gender designation form in New Hampshire.


    By Hannah Calkins

    In this issue of State Beat, we highlight news and accomplishments from three state psychological associations.

    Maine 

    A Maine trial court judge has ruled to uphold a statute that protects neuropsychological and psychological test data, according to Sheila Comerford, executive director of the Maine Psychological Association (MePA).

    The victory came on May 19, about a month after a Maine psychologist informed MePA that opposing counsel had requested the judge to compel him to turn over a patient’s record, including raw test data, to the court. (The judge would then decide whether to release the record to opposing counsel.)

    The request was a challenge to a 2013 law MePA championed that prohibits the disclosure of raw neuropsychological or psychological test data and materials to anyone but another psychologist.

    In response, MePA contacted APA Practice Organization’s Legal and Regulatory Affairs (LRA) staff, who supplied MePA and the psychologist with support and materials to oppose the request.

    MePA was successful: The judge ultimately denied the request, citing that the 2013 law was sound and allowed for no exceptions. The opposing counsel also decided not to appeal this decision, Comerford reports.

    Pennsylvania

    Leaders from the Pennsylvania Psychological Association (PPA) are collaborating with Highmark — a large insurer based in Pittsburgh — to address concerns regarding Highmark’s monitoring of the use of current procedural terminology (CPT) code 90837 (psychotherapy, 60 minutes with patient).

    Rachael Baturin, MPH, JD, who is director of legal and regulatory affairs at PPA, reports that in the summer of 2016, some members began receiving letters from Highmark that seemed to be attempting to deter them from using CPT 90837. These letters were addressed to psychologists who allegedly used 90837 at a high rate compared to other psychologists in the network.

    Some psychologists feared they would be targeted for an audit, though Highmark maintains that the letters were meant to be “educational” rather than threatening, Baturin says.

    In response, PPA and the Practice Organization’s LRA staff contacted Highmark, which confirmed that the letters were truly intended to be educational, not punitive. They also said they do not presume that a more frequent use of 90837 involves inappropriate billing, according to Connie Gallietti, JD, LRA’s director of legal and professional affairs.

    Since then, PPA has been working with Highmark to change their practices regarding CPT 90837. Highmark has asked for input in how to change the tone of their letters and how to better understand the practice settings in which the code might apply.

    Baturin says that PPA is communicating this update to members, and will continue to monitor the letters that Highmark sends regarding CPT 90837.

    New Hampshire

    People in New Hampshire who wish to change how their gender is listed on their identification cards must file a “Change of Gender Designation” (PDF, 49KB) form with the Department of Motor Vehicles (DMV). A health care provider’s signature is required to certify the form and the provider must check a box indicating the kind of provider they are — and there is no box for psychologists, according Leisl Bryant, PhD, ABPP, the executive director of the New Hampshire Psychological Association (NHPA). The form only recognizes physicians, APRNs, clinical social workers, and clinical mental health counselors.

    Bryant says that this was brought to NHPA’s attention over a year ago when a member reported he was unable to complete the form for his patients. Since then, leaders and members of NHPA have been engaged in an effort to add psychologists to the form by writing letters, sending emails and repeatedly contacting the director of the DMV. NHPA has been told by the director’s office that their communications have been received, and that “someone” will be in touch.

    “The response from the DMV has been disappointing so far, but we continue to see this as an important issue and are committed to finding resolution,” Bryant says. She is working with the Practice Organization’s LRA staff to coordinate an approach.

  • June 06, 2017 3:58 PM | Kelly Wetzel (Administrator)

     To Repeal and Replace Obama Care (ACA)?  The initially proposed House of Representatives “repeal and replace Obama Care” legislation (The American Health Care Act of 2017 [H.R. 1628]) was estimated by the non-partisan Congressional Budget Office (CBO) to result in an additional 14 million individuals being uninsured, which would bring the number of uninsured Americans to 21 million in 2020 and 24 million in 2026.  In 2026, an estimated 52 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law (the Affordable Care Act).  That effort lacked sufficient support and the highly anticipated vote was postponed on March 24, 2017.  Subsequently, a revised bill passed the House on May 4, by a vote of 217 to 213 without any Democratic support.  Interestingly, this was done prior to receiving an updated CBO impact statement.

    The APA voiced its disappointment, resulting in APA President Tony Puente calling the legislation: “Significantly worse than the version considered last month.  The bill now opens the door to health plans once again charging exorbitant premiums to the tens of millions of Americans with pre-existing conditions.”  The U.S. Senate is in the beginning stages of developing its recommendations – having to reconcile dramatically different, strongly held views among its members.  For those concerned about mental/behavioral health and substance use services, the critical issue is whether the “essential services” provision of the current law are retained and to what extent the Congress might provide the various state Governors with sufficient flexibility to essentially eliminate the progress made over the past decades in enacting federal mental health parity legislation.

    This ongoing national debate on health care reform is occurring within the context that the United States continues to spend more on health care than any other industrialized nation and without expected comparable health outcomes.  Dean Art Kellermann of the USUHS School of Medicine reports that the National Academy of Medicine (formally, the IOM) estimates that we waste $750 billion per year on “unnecessary or inefficient services, excessive administrative costs, high prices, healthcare fraud and missed opportunities for prevention.”  Those primarily in private practice should appreciate that a significant number of health policy experts are increasingly coming to the conclusion that as a nation we are steadily approaching the enactment of a comprehensive “single payer” system under which government would play a major role in determining what is considered “quality health care” and what percentage of the economy will ultimately be allocated to these services.  Since 1948, the World Health Organization (WHO) has taken the proactive policy position: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”  Without question, health care is a highly complex and evolving endeavor – with behavioral health often underappreciated.

                State-Based Insurance Exchanges:  The decision to establish state-based insurance exchanges, as envisioned by the ACA, was a major policy and operational commitment by 16 states and the District of Columbia.  Last year the Milbank Memorial Fund sponsored a gathering of many of the original leaders of these exchanges to reflect upon the “lessons learned” and implications for future health system reform efforts by state policymakers.  What should be the role of state government in assuring that theirhealth system delivers on the goals of improved population health, efficient care, and a better patient experience of care?  How to develop and maintain the capacities to implement agreed upon policy decisions?

                The ACA provided three options for a state-based exchange’s legal structure: public agency, quasi-governmental agency, or nonprofit organization, with each model being represented.  Upon reflection, the directors expressed an overwhelming feeling of privilege and gratitude on being chosen to lead their state’s historic efforts at building a state-based exchange.  At the same time, many reported being challenged by the level of scrutiny, media attention, and political divisiveness that accompanied their every move.  They emphasized the importance of having national and state political backing, both to support the launch of the new exchange and to build the broad public support needed to enroll those eligible for coverage.  Retired US Navy nurse Coral Andrews, who was our Hawaii director, was particularly touched that President Obama personally joined one of their conference calls, lending moral and political support.

                While all involved were deeply grateful for the opportunity to serve as director, they acknowledged that this was a very intense, 24/7 responsibility.  That only a relatively small number of the original directors remain in the role today reflects the demands of the position and the changing political support for this reform.  For future state-based major health system reform efforts it will be important to remember that those recruited for these positions will need strong support from their state’s leaders.  Regardless of the political context and the policy positions adopted, certain capacities are needed to develop and implement major health reforms: clearly defined leadership, governance, roles, and mechanisms; staff capacity; and federal resources and assistance from other sources.  Leadership was especially challenging because of what was described as working in a fishbowl-type environment, where they often faced a contentious political environment.  Their strategy for dealing with this was to strive for bipartisan support and actively engage stakeholders.

    All agreed that it was absolutely necessary to have a great relationship with and support from the Governor’s office.  It was important to secure the Governor’s leadership to “prioritize operational practically over political opportunity.”  Having a strong advisory process was also viewed as critical and all agreed that the exchange structure must have “clear accountability with a single point of authority.”  Similarly, a clear and effective partnership with the Medicaid program, without being swallowed or subsumed by it, was necessary.  Developing sufficient data to demonstrate progress to legislators and other stakeholders was extremely helpful.  Not surprisingly, recruiting qualified and committed staff was a major challenge for all of the directors.  Both public-sector and private-sector expertise was critical.  The biggest recruiting challenge all of the exchanges faced was finding skilled IT professionals.  Relying on a public-private partnership model requires a clearly articulated and shared vision to enable its success.  Partnership models must align accountability and responsibility to optimize success.  For all of us, the challenges and opportunities ahead are unprecedented.

                Integrated Interdisciplinary Care:  One of former APA President Susan McDaniel’s personal priorities was preparing psychology for the evolving challenges occurring within the nation’s health care environment.  Integrated and interdisciplinary team-based care is one of the foundations of the ACA.  Earlier this year, APA announced the development of an exciting curriculum for an Interprofessional Seminar on Integrated Primary Care, co-chaired by Jeff Goodie and Ron Rozensky.  Fundamental change can be unsettling for many; however, visionaries such as Susan are laying an impressive foundation for the next generation of colleagues across the nation.  “Oh, play me some mountain music.”  Aloha,

    Pat DeLeon, former APA President – Division 42 – May, 2017

  • May 16, 2017 12:08 PM | Kelly Wetzel (Administrator)

    Continuing Progress at the State Level:  “On April 3, 2017, Idaho became the fifth state in the nation to allow prescriptive authority to psychologists.  After three years of work by the Idaho Psychological Association, the legislation passed both houses without opposition and with only two nay votes.  How did this happen?  Here are a few of the factors that may have contributed.  * Psychiatrists negotiated with us.  The shortage of prescribers in our state is the worst in the nation and physicians and legislators are aware that the situation is desperate in some rural areas.  The physician chair of the House Health and Welfare committee became convinced by repeated meetings with our soft-spoken lobbyist that the training was rigorous.  We learned that the rest of the medical association was leaning our way.  The main concern of our colleagues in psychiatry was that the training be at least equivalent to that of an advanced practice psychiatric nurse practitioner (NP).  They brought in an experienced NP to vet our training and the language of equivalence is written into the bill.

                “* One of our state universities agreed to put together a two year full-time masters in psychopharmacology program taught through the pharmacy program.  We know that the training offered elsewhere is excellent but we couldn’t convince our MD colleagues that it was equivalent to a full-time program.  A full-time training where they could have input tipped the scales for them.

                “* We strongly believe collaboration is best for both patients and practitioners.  We have written it into the law and have an advisory committee of psychologists, physicians and a pharmacist to assist our Board of Psychology on RxP issues.  To move from a conditional certificate to a full certificate, two years of supervised prescribing past the masters is required.  To work with children or the elderly, one of those years must be in that specialty.

                “* Our state association was involved and we received unflagging backing from our members, our Executive Director Deb Katz, our association President Page Haviland, and our lobbyist.  “A link to our full bill is: https:legislature.idaho.gov/wp-content/uploads/sessioninfo/2017/legislation/H0212.pdf.

                “We also have been asked why the most conservative state in the union would pass such a bill.  Our answer is that the legislation is completely non-partisan.  It appeals to liberals, conservatives, even libertarians.  The core idea is that once we demonstrate need and can vouch for rigorous training, it comes down to free-market issues.  Since we can prove that psychologists can prescribe safely, we then ask only that the playing field be level and that we be allowed to prove our worth.  We request no money from the state nor do we ask for any guild protection.  If the market works as it should, in a few years we should be able to demonstrate more practitioners, more widespread service, a movement into rural areas and a better fee structure.

                “One unanticipated outcome:  Three years ago we continuously were asked to define the differences between a psychologist, a psychiatrist and a counselor.  We are not asked that so much anymore.  Psychology appears to have established itself as a group of highly trained professionals looked upon with favor by our legislators.  There are only a few hundred of us in this very rural state.  It is deeply satisfying to see the profession become known and appreciated [Susan Farber, former IPA President].”  An historical note – one of the initial RxP training programs involved the School of Pharmacy at the University of Georgia and Georgia State University faculty, pursuant to the vision of Linda Campbell, former member of the APA Board of Directors, and Cal VanderPlate.  More recently, Judi Steinman at the University of Hawaii at Hilo College of Pharmacy provided RxP training for those in Hawaii and the Pacific Basin.  In addition, Morgan Sammons and Robin Henderson report that the State of Oregon House of Representatives passed their RxP legislation unanimously this spring.  Interdisciplinary collaboration is the future for psychology and for our nation’s overall health care system.

                Developments at the Federal Level:  During a recent Give an Hour event, hosted by President Barbara Van Dahlen, USUHS psychology graduate student Elizabeth Belleau met VA Secretary David Shulkin and Harold Kudler, chief consultant for mental health service.  Among other issues, they discussed the exciting potential for active duty mental health graduate students to obtain supervised clinical experience within the VA – especially since these future colleagues personally appreciate the nuances of military culture and will themselves eventually become VA beneficiaries.  HRSA reports that 30 percent of the new hires by Federally Qualified Community Health Centers (FQHCs) over the past two years have been Veterans.  Heather O’Beirne Kelly, APA’s Director of Military and Veterans Health Policy – a position created earlier this year by Interim CEO Cynthia Belar and President Tony Puente – recently had the opportunity to present testimony before the U.S. House Appropriations subcommittee with jurisdiction over the VA.

                “The Department of Veterans Affairs (VA) is the largest single employer of psychologists, who work both as research scientists and clinicians committed to improving the lives of our nation’s Veterans.  As the largest provider of training for psychologists, the VA also plays a vital role in ensuring that the mental health workforce is equipped to provide culturally competent and integrated mental health services to Veterans and their families.”

                “VA psychologists play a dual role in providing care for Veterans and conducting research in all areas of health, including high-priority areas particularly relevant to Veterans, such as: mental health and suicide prevention, traumatic brain injury (TBI), substance abuse, aging-related disorders and physical and psychosocial rehabilitation.  VA psychologists are leaders in providing effective diagnosis and treatment for all mental health, substance use and behavioral health issues.  In addition, VA psychologists often receive specialty training in rehabilitation psychology and/or neuropsychology, which helps to improve assessment, treatment, and research on the many conditions affecting Veterans, including: post-traumatic stress disorder (PTSD), burns, amputation, blindness, spinal cord injuries and polytrauma.  Equally important are the profoundly positive impacts of psychological interventions on the care of Veterans suffering from chronic illnesses such as cancer, cardiovascular disease, HIV and chronic pain.”

                Every day 20 Veterans commit suicide which is unquestionably a major public health tragedy that calls for innovative interventions.  Secretary Shulkin has entered into a partnership with the Department of Health and Human Services to allow the assignment of U.S. Public Health Commissioned Corps members to provide direct patient care to Veterans in VA hospitals and clinics in underserved communities.  During her testimony, Heather raised two related issues.  She discussed psychology’s historical leadership role in developing and providing telepsychological care (within the VA and the Department of Defense) and she recommended as an innovative strategy for addressing suicides by Veterans through enhancing access, continuity, and integration of care: “Granting specially-trained psychologists prescriptive authority analogous to that granted by the Department of Defense for almost 20 years, which will alleviate mental healthcare access issues.”  After her testimony, one of the subcommittee members followed her out of the hearing room and stated that “I want that pilot program.”  Will an already prescribing USPHS psychologist be assigned?

                A Vision for the Future:  In his prior position as VA Under Secretary for Health, Secretary Shulkin was instrumental in providing full practice authority for VA advanced practice registered nurses (APRNs) (with the exception of nurse anesthetists) as long as they were working within the scope of their VA employment.  APRNs now can provide care, regardless of historical state or local legal restrictions, without the clinical oversight of a physician.  This includes taking comprehensive histories, providing physical examinations; and diagnosing, treating, and managing patients with acute and chronic illnesses and diseases.  It also allows APRNs to prescribe medications and make appropriate referrals.

                Under the Secretary’s leadership, in April of this year the VA announced its top five priorities which included Suicide Prevention – Getting to Zero.  The number two priority was Improving Timeliness, highlighting the potential contributions of telehealth.  The Department reported having established 10 Tele-Mental health hubs and 8 Tele-Primary Care hubs.  Not surprisingly, 45 percent of telehealth services are for rural veterans.  Overall, there were 2.14 million episodes of telehealth care provided to 677,000 Veterans, of which 336,000 were TeleMental health visits.  Under the leadership of Robert Zeiss and now Ken Jones, the VA Office of Academic Affiliations has been providing significant support for psychology post-doctoral training initiatives.  The VA has long fostered internship level training in psychology, with over 675 positions nationally located in 49 states plus Puerto Rico and the District of Columbia.  Post-doctoral training did not truly take off until the 2000-2001 academic year, when the number of funded residency positions expanded from five to 38.  These numbers have grown steadily, with a particularly large increase in 2008-2009, when the positions increased from 117 to 204 in just one year.  Currently, that number stands at approximately 440 annually – covering a wide range of clinical areas, as Heather noted in her testimony.  Psychology is well positioned to capitalize upon, and provide leadership for, the exciting potential for innovation which the proponents of telehealth envision.

                Art Kellermann, Dean of the School of Medicine at USUHS and a member of the National Academy of Medicine (formerly the Institute of Medicine), has similarly called for Embracing Telehealth while Rethinking the U.S.’s Military Health System.  “In deployed settings, the military health system uses telehealth to support health care providers working in small forward operating bases and on ships at sea.  Global teleconferencing allows trauma experts across 12 time zones to regularly meet, discuss complex cases, and identify opportunities to improve.  Despite its success with telehealth overseas, the military health system was slow to adopt it at home due to stringent information security requirements and budgetary constraints.  Section 718 of the NDAA [National Defense Authorization Act] directs the military health system to rapidly expand the use of telehealth in its clinical operations.”

                Licensure mobility is critical to the effective use of telehealth services and psychology has been well served by the vision of Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB) in establishing their Interjurisdictional Compact (PSYPACT).  Linda Campbell and Fred Millan served as co-chair of the joint APA/ASPPB/APAIT Task Force for Telepsychology Guidelines.  “And those who look only to the past or present are certain to miss the future.”  Aloha,

    Pat DeLeon, former APA President – Division 29 – May, 2017

  • May 16, 2017 11:40 AM | Kelly Wetzel (Administrator)

    By Hannah Calkins

    After nearly a decade of conflict and deadlock between psychologists and a religious lobbying group, Nebraska may become the only state whose ethical code for psychologists excludes anti-discrimination protections for LGBTQ people, the Lincoln Journal Star reported on April 15.

    Since 2009, state officials in Nebraska have blocked the approval of updated psychology regulations without the inclusion of a so-called “conscience clause” that would allow psychologists to deny professional services — including referrals — for patient problems relating to sexual orientation.

    The demand for the addition of a conscience clause comes from the Nebraska Catholic Conference (NCC), an organization which appears to have significant influence with the state government, says William Spaulding, PhD, who is co-chair of state government affairs at the Nebraska Psychological Association (NPA).

    “The purpose of psychology regulations, as required by the state constitution, is to protect the public — not to endorse the personal beliefs of licensed psychologists,” he says.

    Prohibition of discrimination based on sexual orientation has been included in psychology licensing regulations since 1992. However, the NCC is now arguing that state licensing boards don’t have the authority to “add new protected classes” to their regulations — and Nebraska's anti-discrimination laws do not include language about sexual orientation or gender identity.

    The history of the conflict

    The acknowledgment of this legal strategy by the NCC marks a new development in a conflict that began nearly nine years ago. 

    In the fall of 2008, the Nebraska Board of Psychology completed a comprehensive revision of licensing regulations. Some of the regulations had been updated in 2004, but others were last revised in 1992.

    In early 2009, the Nebraska Department of Health and Human Services (NDHHS) informed the board that the revised regulations would not be approved because the NCC insisted on the addition of the conscience clause, Spaulding says.

    Since that time, the revised regulations have been frozen. Two successive gubernatorial administrations — via NDHHS — have asked the board to accommodate the NCC and reach a “compromise.” 

    But the board, Spaulding and his colleagues at NPA have vigorously opposed any kind of compromise, arguing that that the NCC’s demand is in conflict with Nebraska’s code of ethics for psychologists (PDF, 73KB) (as well as APA’s).

    Last September, NDHHS abruptly — and inappropriately, according to Spaulding — terminated the revisions the board made in 2008 and submitted their own draft of regulations for the board to consider.

    NDHHS’s new director, Courtney Phillips, told the Lincoln Journal Star that this “fresh” draft was intended restart the process of resolving the conflict.

    But, Spaulding says, NDHHS’s draft quietly omitted the anti-discrimination language that has been included in Nebraska psychology regulations since 1992.

    New attacks on anti-discrimination language

    At a meeting of the Board of Psychology on March 31, Spaulding says NPA leadership called upon the board to reject NDHHS’s draft. The board passed a motion to request further explanation from Phillips regarding the termination of the revised regulations, as well as the omission of the anti-discrimination language.

    According to Spaulding, the omission is in step with the NCC’s newest tactics.

    He says the NCC’s targets in the conflict have shifted over the years. At first, their concern was that psychologists would be forced to provide marital therapy to same-sex couples. When NPA and the board explained that psychologists are free to decline to treat people as long as they provide an appropriate referral, NCC focused on the nature of the referral.

    Recently, “their focus has shifted again to eliminating anti-discrimination language altogether, and that’s what the issue is now,” Spaulding explains.

    NPA, which has been engaged in a persistent advocacy effort from the beginning of the conflict, remains committed to opposing the NCC’s agenda. That effort has recently been made public in several articles and op-eds in the Omaha World Herald and Lincoln Journal Star, and they have garnered significant support from Nebraska State Senator Adam Morfeld (D-46).

    But as the conflict grinds on, Nebraska’s psychology regulations — some now 25 years old — are growing very outdated. The stalled 2008 revision included many important updates, such as: clarified distinctions between consultation and supervision; a more detailed explanation of psychological testing; new record-keeping requirements; an extension of the timeframe for completing postdoctoral requirements; and the adoption of APA’s current code of ethics.

    “The NCC’s proposed change protects nobody — not the public, not our patients, and not even psychologists, who have never been disciplined for conscience-related complaints in Nebraska,” Spaulding says.

    In this case, he continues, the NCC’s interventions “serve no purpose other than to assert their agenda of promoting discrimination against people of diverse sexual orientation. It is a gross politicization of health care regulation.”


    The writer is the daughter of Anne Talbot, PsyD, who is president and former executive director of the Nebraska Psychological Association.

  • April 19, 2017 9:34 AM | Kelly Wetzel (Administrator)

    The latest on psychological and neuropsychological testing codes.

    By APA Office of Health Care Financing Staff

    Practicing psychologists need to know almost as much about billing codes as they do about their patients. Every year, the American Medical Association (AMA) publishes thousands of Current Procedural Terminology® (CPT) codes that psychologists and other health care providers use to bill insurers for treatment. The manual includes psychotherapy, health and behavior, and testing codes that are revised periodically by the AMA CPT Editorial Panel. This panel is responsible for ensuring that CPT codes remain up to date and incorporate the latest treatments and technology used to provide medical care.  

    The American Psychological Association works with the AMA CPT Editorial Panel to keep the manual updated. Psychologists also play a role in establishing the value of new codes when they complete Relative Value Update (RUC) surveys. AMA uses RUC survey responses from psychologists and other health care providers to help review the relative values of new and revised CPT codes.

    Anticipated code changes

    Currently, psychological and neuropsychological testing CPT codes are being revised by the AMA CPT Editorial Panel. APA is heavily involved with this process. Here’s what psychologists need to know: 

    • The final testing code revisions would “differentiate technician administration of psychological testing and neuropsychological testing from physician/psychologist administration and assessment of testing.” In the past, existing codes have caused confusion about who is performing these tests.
    • APA is making refinements to testing codes that will be submitted to AMA for publication in a future CPT manual.
    • Practicing psychologists can now follow the progress of the code revisions by reading summaries of CPT Editorial Panel meetings online. In previous years, because of the confidential nature of the code development process, most psychologists and other health care practitioners were unaware of code changes until the new or revised codes were published in the annual CPT codebook.

    APA has collaborated with AMA for many years to ensure that the work of practicing psychologists is taken into consideration when developing new CPT codes and revising existing codes. APA President Antonio E. Puente, PhD, even served two terms on the AMA CPT Editorial Panel and was an advisor to the panel from 1992-2007. Additionally, APA’s Office on Health Care Financing is dedicated to working on CPT codes.

    Psychologists can learn more about the CPT code development process by reading editorial panel meeting summaries on the AMA website and visiting the APA Practice Organization’s reimbursement section on APA Practice Central.

  • April 06, 2017 12:56 PM | Kelly Wetzel (Administrator)

    “COME ON AND HEAR!  COME ON AND HEAR!”

                The 34th Annual APA and Practice Leadership Conference (PLC):  As always, the APA and Practice Organization’s State Leadership Conference (SLC), this year renamed the Practice Leadership Conference (PLC), was an outstanding success.  Dan Abrahamson and Susie Lazaroff were truly visionary in crafting the agenda for “Practice, Politics & Policy.”  Former Administration and Hill operatives provided an insightful glimpse into the new Trump Administration and what psychology’s practitioners might well face over the next four years.  One could feel a growing sense of urgency among those present for getting personally involved in shaping the future of our nation’s health care environment and especially for ensuring that psychology remains recognized as a bona fide autonomous health care profession.  Having worked on the U.S. Senate staff for over 38 years, I particularly appreciated Katherine Nordal’s challenge to advance the trade of professional psychology – a conceptually different approach than many have heard before.  She also noted that the psychology PAC currently ranks 44th among 129 health professional PACs with dentistry, medicine, optometry, nursing, physical therapy, podiatry, social work, and psychiatry significantly ahead of us.

                APA President Tony Puente and President-Elect Jessica Henderson Daniel were constantly mingling among the 400+ attendees at PLC, urging colleagues to appreciate that the future of their profession lies in their own hands.  Once again, the number of first-time attendees was most impressive.  Our national leadership was especially attentive to the early career psychologists and graduate students who were present.  Division 55 should be proud that under the leadership of Presidents Neal Morris and now Sean Evers, USUHS graduate students Joanna Sells and Omni Cassidy have been actively engaged in shaping our Division’s annual convention programming.  As Dan Abrahamson reflected afterwards: “If we can’t support the future of our profession, we are done for….”

    Sybil Mallonee (1st Lt., USA) is a graduate student at USUHS: “As a student attending the APA’s Practice Leadership Conference for the first time, it was an amazing and exciting experience.  It was amazing seeing so many clinicians from all stages in their career come together to advocate for our field.  It was exciting to have the opportunity to be mentored by so many incredible clinicians who were eager to pass on their knowledge to the upcoming generation of psychologists.  It was also exciting to see such an emphasis on the importance of diversity and on having the sometimes challenging conversations around issues related to diversity.  There were many great speakers throughout the conference, but the one that stands out the most was the diversity panel.  This panel was of psychologists sharing challenging conversations and experiences related to diversity.  In keeping with the theme of the conference as a whole, their stories were inspiring to this future psychologist.  They were honest and challenging, but they also emphasized the importance of not losing your voice and of standing up for what is right.”

                Psychology Proudly Serving the Nation:  Cynthia Belar, Interim APA CEO, recently reported to the Council of Representatives: “Dr. Heather O’Beirne Kelly is now APA’s first Director of Veterans and Military Health Policy.  Dr. Kelly has served as a Senior Legislative & Federal Affairs Officer for the past 19 years in APA’s Science Directorate, where she has led our association efforts to address military and veteran issues and to promote the role of psychology in tackling those issues.  In her new role Dr. Kelly will join Practice’s government relations office, headed by Doug Walter, J.D., and she will work across directorates to ensure that the range of military and veteran issues are addressed.  One out of every six Americans is either a military service member, veteran, or family member of someone serving or having served in the U.S. armed forces.  APA has a long history of attending to the health and well-being of these populations, and the VA is the largest single employer of psychologists.  We believe that in this new role, Dr. Kelly will enhance our advocacy and work to better serve our service members, veterans, and the psychologists who care for them.”  As many of us aware, Heather has been working closely with the Division to expand psychology’s RxP capabilities throughout the federal system, including within the VA. 

                On Veterans’ Day 2016, a long-time friend, Kris Ludwigsen shared her reflections with her local congregation on her personal service in the USAF.  “Today I would like to focus on the women who’ve volunteered to serve in the military.  I am a veteran of Desert Storm and my father was torpedoed in the Navy in WWII.  A Scottish ancestor, Daniel McClure, fought in the American Revolution at the battle of Ft. Vincennes, and 200 years later I went on active duty in the USAF.  We all survived the dangers of our tours of duty in the Army, Navy, and Air Force.

    “Women of verve formed a militia of ‘minutemen,’ or stepped up as spies for the American Revolution.  In the Civil War they disguised themselves as men to fight with their husbands.  While Rosie went to work building battleships and bombers to backfill positions vacated by men, in WWII the WASPs flew hundreds of missions over some 64,000 miles; yet they were only granted veterans’ status in 1977.  In the wake of the WACs (1943) and the WAVES (1944) came the Army nurses tending the wounded in Viet Nam and the women of the National Guard who were deployed to grunt work and combat in Iraq and Afghanistan.

                “Why would a woman choose to join the military?  Some volunteer out of a desire to serve their country or family tradition, the same as a man.  Some join for adventure or travel, to be exposed to a broader view of the world.  Some join for financial independence and a structure that makes it possible to leave home or support children on their own.  Some sign up for training and educational opportunities.  For me it was the professional experience.  Teaching in a university and rubbing elbows with part-time instructors who were active duty psychologists at Wright-Patterson AFB, I wanted the immersion clinical experience the Air Force provided.

                “The military is a microcosm of society that includes physicians and nurses, social workers and psychologists, dentists and dieticians, attorneys and chaplains – as well as missile launchers and those fighting on the front lines.  It is a milieu with valuable lessons to teach.  The military is about learning responsibility and reliability, resourcefulness, leadership and teamwork with pride in an esprit de corps.  It is about courage under fire, proving yourself as an adult without the support of family, and about submerging your ego to the mission, to the common objective.

                “As the first military psychologist at an 18-bed hospital, I had an advantage in that no one really knew what a psychologist did.  So I was able to create my own job description that included meeting with the squadron commander or first sergeant to explain the dynamics that had resulted in the member’s problem behavior, often the precursor to discharge.  After assessment and treatment my goal was to integrate the member back into the squadron to salvage his or her Air Force career.  When a stream of young women from Dugway Army Proving Ground was admitted, I decided to investigate the cause, and drove out to the desert once a month to run an enlisted women’s morale group.  In such isolated surroundings, these women were being harassed by their male counterparts, resulting in acute stress disorder symptoms that precluded functioning on the job; and I worked with the company commander who had them transferred out of a hostile work environment.  

                “The transition back to civilian life is not easy; war time separations foster family problems difficult to repair.  Many Vets have suffered the toxic effects of Agent Orange or symptoms of post-traumatic stress disorder as I found working with retirees who’d served in Viet Nam, and with a nurse-friend who endured SCUD missile attacks in Desert Storm.  We must do more to help support Vets whose special needs originate from having given their all, for Service Beyond Self.  I went in as a Captain and retired as a Lieutenant Colonel line officer some 25 years later.  The Air Force was the most creative and exciting period of my 35-year career as a psychologist.  As a ‘lone ranger’ I learned that if I didn’t do it, it wasn’t going to get done.  I had to establish priorities for treatment and I had to grasp what it was like to be in the shoes of the diverse members of this military community.  In my time I met a number of men and women who earned my respect as true public servants, dedicated to the highest aims.  Remembering our Vets and those who continue to serve us in the military is our duty and professional responsibility.”

                The Future of Advanced Practice Nursing:  The Robert Wood Johnson Foundation (RWJ) has released its report Charting Nursing’s Futurehighlighting the progress our 350,000 APRN colleagues have made in obtaining full practice authority.  Twenty-two states and the District of Columbia allow APRNs to practice to the full extent of their education and training.  Final VA regulations, citing federal preemption authority, authorize its 5,825 APRNs (excluding nurse anesthetists) to follow national practice guidelines covering basic prescriptive authority, admissions; and eliminate previous physician supervision requirements, notwithstanding more restrictive state or local laws.  “It’s the best band in the land!”  Aloha,

    Pat DeLeon, former APA President – Division 55 – March, 2017

  • March 28, 2017 3:25 PM | Patrick Litle

                The APA and APA Practice Organization annual State Leadership Conference – this year renamed the Practice Leadership Conference (PLC) – is always one of the highlights of my year.  Dan Abrahamson and Susie Lazaroff did an outstanding job.  Over 400 enthusiastic colleagues convened in our nation’s Capital for the 34th conference; highlighted by the Monday evening recognition of Congressman Tim Murphy’s landmark efforts on behalf of our nation’s mental health and substance abuse initiatives.  APA President Tony Puente and President-Elect Jessica Henderson Daniel were ever-present, with Tony envisioning the Rebirth of APA as he actively engaged with numerous graduate students and Early Career Psychologists.  The Plenary Session, featuring former congressional and administration operatives, entitled “Inside the White House and the 2017 Political Landscape” provided fascinating insights into the current political dynamics and an intimate sense of the perhaps unprecedented changes evolving.

    The landscape for professional practice is definitely changing: how one will get reimbursed for providing care, the challenges and opportunities of integrated healthcare, the advent of technology -- social media and telehealth -- with the need for licensure mobility, and addressing the culture of business, law, and medicine.  Katherine Nordal’s challenge for psychology “to appreciate the importance of being at the table” was most timely.  She conceptualized promoting psychologists by advancing the trade of professional psychology – truly a new message for a number of our colleagues – and by contributing to our Political Action Committee (PAC).  Today, the psychology PAC ranks 44thamong 129 health professional PACs with dentistry, medicine, optometry, nursing, physical therapy, podiatry, social work, and psychiatry significantly ahead of us.  The key to our long term survival as an autonomous profession is, and always has been, visionary leadership within our State Associations.

                During President Donald Trump’s inaugural address at the Joint Session of Congress, he offered a vision for America in which: “(T)he time has come to give Americans the freedom to purchase health insurance across State lines – creating a truly competitive national marketplace that will bring cost way down and provide for better care.”  Those who have been involved in earlier state association legislation will recall the heroic efforts of former APA Presidents Nick Cummings and Jack Wiggins in the 1970-80s to enact “Freedom of Choice” legislation which ensured that psychological services would be readily available to patients.  President Trump further noted: “We should help Americans purchase their own coverage… but it must be the plan they want, not the plan forced on them by the Government.”  “We should give our great State Governors the resources and flexibility they need with Medicaid to make sure no one is left out.”

    With flexibility comes the potential for eliminating a wide range of previously mandated health benefits, including those for mental health and substance abuse.  Not surprisingly, the GOP crafted healthcare legislation to “Repeal and Replace Obamacare” proposed that beginning in 2020, their plan would eliminate the mandate that Medicaid cover basic mental health and addiction services in those states that expanded their plan – adversely impacting 1.3 million Americans.  Their initial effort begins with Medicaid with further legislative proposals anticipated later on this Congress.  Theoretically, as psychology becomes more intimately integrated within the nation’s overall healthcare system – as has been increasing the case within the public sector especially within the VA and DoD -- there will be little need for mandating our services.  However, if psychology is not at the table as Katherine urges, “we may be on the menu.”  “Your relationships with friends and family.”  Aloha,

    Pat DeLeon, former APA President – Division 31 – March, 2017

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