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  • 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 (Administrator)

                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

  • March 28, 2017 3:23 PM | Patrick Litle (Administrator)

    Several hundred psychologists traveled to Washington, D.C., to advocate for expanded mental health care coverage during the Practice Leadership Conference.

    By Hannah Calkins

    Every March, psychology’s leaders from all over the United States and Canada convene in Washington, D.C., for the Practice Leadership Conference. On the final day of the conference — after three days of rigorous dialogue, education and advocacy training — delegates from each state go to Capitol Hill to lobby their senators and representatives on behalf of their patients and profession.

    This year, Hill Visit day fell on March 7. It turned out to be a fortuitous day for psychologists to advocate for mental health coverage: Just the night before, House Republicans released their plan to repeal and replace the Affordable Care Act (ACA), sending politicians and staffers all over the Hill into frenzied uncertainty. The psychologist advocates were not demoralized by these developments, but instead energized, focused and optimistic.

    “Today is a great day to be here. There is a void that is being created by changes to the health care law, and it’s important that mental health services get pulled into the vacuum that is created by that void,” said Deborah Okon, PhD, who was waiting with her colleagues from the New Mexico Psychological Association (NMPA) for a meeting with a staff member from the office of Rep. Michelle Lujan Grisham, D-N.M.

    Okon, who has served as a federal advocacy coordinator — a psychologist appointed by their state psychological association to organize grassroots advocacy efforts — for NMPA for nine years, said that she and her colleagues stayed up late studying the Republicans’ bill. Grisham’s staff member was grateful for this preparation during their meeting, as he hadn’t yet read the whole bill.

    Okon raised her concerns to the staffer, noting that the bill stipulates that coverage for mental health and substance abuse services would be optional. “We think funds for those services should be mandatory,” Okon told him.

    On the other side of the Capitol, delegates from the Rhode Island Psychological Association (RIPA) were shuttled from an antechamber outside a Senate judiciary confirmation hearing and into a busy hallway to meet with Sen. Sheldon Whitehouse, D-R.I.

    “We’ve found our congressional delegation from Rhode Island to be very receptive to our concerns,” said Wendy Plante, PhD, RIPA’s federal advocacy coordinator, after the meeting. “They appreciate hearing our stories from the state, especially in this tough political climate.”

    Psychologists who met with members of Congress who do not support the ACA may have gained more traction with a second talking point: requesting co-sponsorship of the Medicare Mental Health Access Act, which would include psychologists in Medicare’s “physician” definition.

    Diane Marti, PhD, and Jim Madison, PhD, of the Nebraska Psychological Association (NPA), emphasized this point in their meeting with Sen. Deb Fischer, R-Neb. Drawing on compelling examples from their professional and personal experience, Marti and Madison effectively conveyed to the senator how the exclusion of psychologists from the physician definition obstructed access to care.

    Marti, who is both president-elect and public education coordinator of NPA, said after the meeting that she appreciated getting face time with Fischer. “She seemed open to using us as resources, and I think we appealed to her on a basic, personal level — how can you help us, and the people we serve, as a fellow Nebraskan?” Marti said.

    Later, Andrew Fink, PsyD, and Matthew Syzdek, PhD, both early career psychologists with the Minnesota Psychological Association (MPA), reflected on their day. They had just come from a meeting in the office of Sen. Al Franken, D-Minn., where the staffer they spoke with assured them that “the boss” supported their work.

    "Our visits today went well. Speaking with the Republican side was interesting. I think we made some persuasive arguments to them about the economic end of things,” Fink said.

    Syzdek agreed. He said that their meetings on the Hill were productive, but it was important to continue their advocacy at home. “Psychologists need to take a two-prong approach,” he said. “Today we met directly with lawmakers; tomorrow, we have to reach out in our communities.”

    For more stories and photos from psychologists’ visit to the Hill, search #PLC2017 on Twitter. 

  • March 28, 2017 3:20 PM | Patrick Litle (Administrator)

    Learn about upcoming changes to EPPP, the exam state and provincial psychology boards use to make licensing decisions.


    By Rebecca A. Clay

    Changes are coming to the licensing process: In 2019, the Association of State and Provincial Psychology Boards (ASPPB) plans to launch a new licensing exam.

    Last year, ASPPB’s board voted to add a second step to the Examination for Professional Practice in Psychology (EPPP), which state and provincial psychology boards use to make licensing decisions. While the original exam tests knowledge, the EPPP Step 2 will test whether candidates have the skills needed to work independently.

    “Adding this exam provides a standardized way of measuring future psychologists’ professional skills,” says ASPPB Chief Executive Officer Stephen T. DeMers, EdD, noting the wide variation among training programs and approaches to clinical supervision. “To ensure public protection, which is the responsibility of licensing boards, we felt the need to have a standardized measure of minimal competencies in professional skills.”

    Many have questioned what has prompted ASPPB to create Step 2, says DeMers, noting that there has been no increase in complaints about unskilled psychologists. Instead, he says, the exam is the next step in the competency movement that psychology — as well as other health care professions — has been participating in for the last 15 to 20 years. “What’s driving this is a change in the landscape of health care regulation and the health care marketplace, where payers and government officials are demanding that the profession have credibility through competency assessment,” DeMers says.

    The move toward assessing competency makes sense, says Derek C. Phillips, PsyD, a neuropsychology fellow at Psychological and Neurobehavioral Services, PA, in Lakeland, Florida. It could indeed increase credibility and the quality of services, he says. But, he adds, many early-career psychologists “feel it imposes an additional roadblock to a process that already has a lot of roadblocks.”

    Time and money are the primary concerns, says Jennifer M. Doran, PhD, a postdoctoral fellow at the National Center for Post-Traumatic Stress Disorder at the Veterans Affairs Connecticut Healthcare System. “It will not only increase the time it takes to get a license and begin working, but also substantially increase the cost to trainees,” Doran says. “People are saying, ‘We’re all for competency, but this is not the way to do it.’” Instead, Doran and others suggest shifting responsibility for assessing content knowledge to graduate programs. “Let them do your content knowledge assessment and then take one postgraduation exam that’s more competency-focused,” she suggests.

    That kind of feedback is making a difference, says DeMers, noting that it “has changed the dialogue.” ASPPB’s board is now considering the idea of changing its policy and allowing people to take the first EPPP before they receive their doctoral degrees, a move that would speed up the process. Doing so could also save money by eliminating the argument for a postdoctoral year. “The new test will allow licensing boards to be assured that people are ready for practice,” DeMers says.

    None of this will happen quickly, he adds, noting that once the exam has been created ASPPB will still have to work with boards to get local regulations or legislation changed to require Step 2 for licensure. That means there’s plenty of time to share your opinion:

    • Work through APA. Get involved in APA and the APA Practice Organization and share your thoughts with the Committee for the Advancement of Professional Practice and the board of directors, urges Phillips. APA can then share that feedback with ASPPB for it to use in shaping its own decisions.
    • Work with your state psychological association. “Licensing boards ultimately need to support any changes,” says Doran, who encourages early-career psychologists to help their state associations put pressure on their state boards.
    • Contact ASPPB directly. ASPPB’s Step 2 website invites feedback. You can also contact DeMers or Chief Operating Officer Carol Webb, PhD.

    Says Phillips, “I definitely encourage early-career psychologists to make their voices heard, not to merely hope for a good outcome.”

  • March 06, 2017 4:58 PM | Patrick Litle (Administrator)

    APA’s Survey Finds Constantly Checking Electronic Devices Linked to Significant Stress for Most Americans


    For Summary and Press Release:

    http://www.apa.org/news/press/releases/2017/02/checking-devices.aspx


    For Full Report, Go to:

    Part 1:

    http://www.apa.org/news/press/releases/stress/index.aspx#part1

    Part 2:

    http://www.apa.org/news/press/releases/stress/2017/technology-social-media.PDF


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