INNOVATIVE TRAINING OPPORTUNITIES —
FOR THOSE WITH VISION
Pat DeLeon, former APA President
Changing Times: Over a decade ago, in 2003, the Institute of Medicine (IOM) issued its report Informing the Future: Critical Issues in Health. Most noteworthy: “A person’s behavior and social circumstances have a remarkably strong effect on his or her health. Taken together, behavioral patterns and social circumstances are estimated to account for more than half of the premature deaths in the United States each year. Yet medical schools often do not cover these topics or do so only superficially. IOM is conducting a study to identify ways to make the behavioral and social sciences an integral part of medical education.”
Several of psychology’s visionary educators are exposing their students to the medical and interprofessional aspects of health care by developing innovative and accredited training experiences, thereby preparing the next generation of practitioners for the unprecedented challenges and opportunities of the coming century. Gil Newman and Bob McGrath, for example, are placing students within local Federally Qualified Community Health Centers (FQHCs), where they work within primary care, rather than in more traditional co-located specialty mental health services.
The federal health center initiative was created during the Great Society Era of President Lyndon Johnson. They are located primarily in medically underserved areas and are a core component of the health care delivery system for low-income and minority populations. In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), made 85.6 million visits to the nation’s nearly 1,200 FQHCs operating in 8,500 sites. The Commonwealth Fund reports that the percentage of FQHCs exhibiting medium or high levels of medical home capacity almost doubled between 2009 and 2013, from 32% to 62%. Patient-centered Medical Homes and Accountable Care Organizations are a critical component of the Obama Administration’s vision of developing systems of integrated and interprofessional team-based comprehensive care with an emphasis upon prevention.
A Personal Perspective: At the Uniformed Services University of the Health Sciences (USUHS), Neil Grunberg (along with his medical school colleagues Eric Shoomaker and John McManigle) has effectively integrated leadership skills into the annual Operation Bushmaster training program. “Every year in October, students from USUHS Schools of Medicine (including the Department of Medical and Clinical Psychology) and Nursing participate in a four-week training exercise known as ‘Operation Bushmaster.’ The first two-weeks of didactic training provide the groundwork for unit cohesion, with a follow-on week of independent study incorporated for mastery of many of the concepts. During the final week, students ‘deploy’ to a training facility to conduct simulated medical missions and are exposed to many of the same stressors experienced during combat deployments (i.e., lack of sleep, high operational tempo, fatigue, and austere living conditions). Additionally, Operation Bushmaster provides an atmosphere where inter-professional collaboration transpires and learning the unique perspectives of each discipline is highly encouraged.
“During this field exercise, Psychiatric Mental Health Nurse Practitioner (PMHNP) students and Clinical Psychology students played the roles of patients with mental health illnesses such as psychosis, mania, depression, anxiety, and substance use disorders. While simulating roles of Battalion Surgeon (senior medical officer) and Combat Stress Control, the graduating medical students and Family Nurse Practitioners (FNP) students assessed and treated mental health ‘patients’ presenting with acute and chronic symptoms.
“This year, PMHNP students joined with Clinical Psychology students to form the Brigade Combat Stress Control (CSC) team. In this shared role, students evaluated the behavioral health needs of the medical platoons participating in Operation Bushmaster. The Unit Behavioral Health Needs Assessment Survey (UBHNAS) is a comprehensive survey developed to assess the overall behavioral health status and needs of a military unit. However, those of us in mental health developed a shortened version of this tool for use during the training exercise. Our modified UBHNAS assessed the status of each platoon in five critical domains: leadership, leadership cohesion, morale, communication, and training. Following the assessment students provided direct feedback to the Platoon Leader on methods for improvement and in areas for sustainment within each team. Additionally, the Brigade Combat Stress Control team offered brief psychological interventions (such as humor, relaxation exercises (i.e., deep breathing), and discussions of resiliency) to platoon members. On returning from the field, a presentation to Command Leadership was given by the CSC team, where we received feedback on our performance by faculty members [Marlene Arias-Reynoso, Patricia Smith, and Lutisha Jackson, PMHNP students].” View https://www.youtube.com/watch?v=IWNJ6kdQpqY if interested.
Developments in Illinois: On June 25, 2014, Illinois joined Guam, New Mexico, and Louisiana in enacting comprehensive prescriptive authority (RxP) legislation. The Illinois Psychological Association took the innovative approach of opening the Master’s level training in Clinical Psychopharmacology to those who are still at the pre-doctoral level, a far-reaching educational policy position long proposed by former APA President Bob Resnick, Bob Ax, and Gene Shapiro. Furthermore, because the law requires seven undergraduate science courses, Illinois now has undergraduate psychology students enrolling in “pre-prescribing” specialty curricula.
Beth Rom-Rymer’s report: “It’s been 17 months since the Illinois State Legislature passed our prescriptive authority legislation by overwhelming margins and 16 months since former Governor Pat Quinn signed SB 2187 into law. We Illinois psychologists have not let any grass grow under our feet. The process for the approval of our law’s Rules and Regulations is almost complete. We expect that the effective date for our law will be March 1, 2016.
“Two of the largest state Universities in Illinois – the University of Illinois, Champaign-Urbana and Southern Illinois University, with 33,000 and 13,000 undergraduates, respectively, now have the undergraduate concentration for the ‘pre-prescribing psychologist.’ Some of our Universities are planning a 4+1 academic program that will combine the B.S. in Psychology with the M.S. in Clinical Psychopharmacology. Those students who earn the combined degrees will then have a very competitive opportunity when they apply for their doctoral programs in psychology. Several Universities and Professional Schools are working on developing the M.S. curriculum in Clinical Psychopharmacology for their current graduate students as well as for practicing psychologists around the country.
“More than 20 Illinois hospitals and medical centers are creating rotation opportunities for the prescribing psychology trainees. The number of participating hospitals and medical centers continues to grow and includes Illinois’ most renowned teaching hospitals. The legal mandate that we must participate in a series of nine medical rotations (e.g., internal medicine, pediatrics, and family medicine) affords prescribing psychology trainees yet another opportunity to form collaborative alliances with physicians by observing first-hand their treatment procedures while functioning as independent members of multidisciplinary treatment teams. Even our Illinois psychiatrists are more than willing to partner with us to meet the needs of our patients who are desperate for good, accessible mental health care. Over 90 Illinois practicing psychologists are currently in training, ranging in age from 23-83. Our oldest trainee, an addictionologist, asserts that her patients will be better served with her being trained as a prescribing psychologist. We have established strong collaborative relationships with NAMI and various governmental and law enforcement agencies in the state. In a remarkable development, county mental health boards are raising funds to pay for the training of prescribing psychologists in their jurisdictions. There is a growing, widespread recognition that prescribing psychologists can transform a broken mental health system.” Aloha,
Pat DeLeon, former APA President – Division 42 – November, 2015