INTERDISCIPLINARY COLLABORATION – GROWING ENTHUSIASM
Pat DeLeon (former APA President) Column, June 2016
One of the major foundations, and thus challenges, of President Obama’s landmark Patient Protection and Affordable Care Act (ACA) is moving our nation’s health care delivery system towards embracing interdisciplinary (i.e., interprofessional) collaboration and training. In addressing our health policy class at the Uniformed Services University of the Health Science (USUHS) Polly Bednash, former CEO of the American Association of Colleges of Nursing (AACN), described the heartfelt personal commitment of the leadership of six major health professions organizations to radically impact the training experiences of their next generation of colleagues. In 2009, they formed the Interprofessional Education Collaborative (IPEC) with the collaborative partners being the AACN, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy (AACP), the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools and Programs of Public Health. APA joined IPEC in 2015 when its membership was expanded to include other educational/practice organizations committed to the education of clinicians for team-based care. Recent actions by the APA Council of Representatives have been highly supportive of this effort. Cynthia Belar, APA Interim CEO, has been actively involved throughout the process.
Deborah Trautman, the new AACN President and CEO, announced the first annual Health Professions Week (HPW) initiative scheduled for this fall. This will be a week-long event for high school and college students interested in learning more about careers in the health professions. Each event will provide students with interactive opportunities to explore health-related education programs and careers – not to mention an online treasure hunt, on-campus events, and a two-day virtual fair. Students will learn about 18 health professions and have the opportunity to talk directly with current health care providers. The co-chair of this event represents AACP.
The National Academy of Medicine (NAM) (formally, the Institute of Medicine) recently conducted a day and a half workshop on accreditation, which is becoming a major issue for those interested in developing interprofessional clinical placements. The representative from AACP John Ressler: “I was honored to attend a workshop presented by the Global Forum on Innovation in Health Professional Education held on April 21-22, at the National Academies of the Sciences. Engineering and Medicine in Washington, DC. The event was titled The Role of Accreditation in Enhancing Quality and Innovation in Health Professions Education. The purpose of the workshop was to survey ideas from attendees on the impact and role of the accreditation process to enhance the quality of health professional education.
“Attendees represented a broad spectrum of organizations who share interests in positive patient outcomes and provided input on the role, if any, of accreditors to ensure students are adequately capable of providing this care. The Forum provided a number of speakers representing various perspectives and the audience was asked to provide feedback and answers to related questions. Attendees were asked to vote at the end of the workshop on whether accreditors should have input in this process. The result was overwhelmingly positive as attendees believed it is of upmost concern that health professional education, accreditors and the health professions share a ‘social responsibility’ to provide quality health care to society.”
Lucinda Maine, EVP & CEO of AACP, estimates that 40-50 health disciplines were represented at the NAM meeting. Lucinda is one of our regular USUHS policy speakers and has dramatically crystalized the unprecedented changes occurring within the health care environment with her discussions of the American Pharmaceutical Association Code of Ethics. From 1922-1969: “Pharmacists should never discuss the therapeutic effect of a physician’s prescription with a patron or disclose details of composition which the physician has withheld.” However, as of 1994: “A Pharmacist respects the covenantal relationship between the patient and pharmacist. Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.” The current Pharmacy Code of Ethics clearly envisions treating the patient as a co-equal partner in his/her own health care decision making (another far-reaching element of the ACA). On several occasions during class, Lucinda has raised the issue with our next generation: “Why do you call RxP ‘seeking prescriptive authority’? Why not conceptualize obtaining this important clinical responsibility as ‘collaborative practice,’ as we do in pharmacy?” In all but two states clinical pharmacists have obtained the clinical authority (under differing conditions similar to nursing) to modify and/or initiate medications. Her suggestion could significantly change the underlying discussions at the State legislative level.
This spring Lucinda attended APA President Susan McDaniel’s Integrated Primary Care Alliance Presidential initiative held in the Tower Conference Room at APA. Susan hosted a CEO and a leader in the Presidential cycle of 23 different health and mental health professional organizations that compose the integrated primary care team. This list resulted in over 80 participants (pediatricians, internists, family physicians, nurse practitioners, physician assistants, psychiatrists, social workers, clinical pharmacists, etc.). The objective for the weekend was to develop inter-organizational goals to move the needle forward on integrated primary care, which, by definition, will be interprofessional in nature.
A longtime friend and colleague, Alan Kraut, will soon become the Executive Director of the Psychological Clinical Science Accreditation System (PCSAS) which began in 2009 and currently is the accrediting agency for 30 psychology clinical training programs in the U.S. and Canada. PCSAS has been recognized by the Council of Higher Education Accreditation (CHEA) and final regulations for VA recognition are pending. When he was working for APA, Alan was instrumental in hosting professional psychology’s initial Black Tie fundraising dinner at our annual convention in Los Angeles. The recipient that year was U.S. Senator Daniel K. Inouye. Alan has always stressed the importance of applying clinical science in ways that are most effective in improving public health.
A Different Perspective
As Lucinda has suggested, how one conceptualizes an issue can radically shape the ensuing public debate. Those opposed to the expansion of non-physician scope of practices frequently employ an emotional “public health hazard” argument; i.e., they would affirmatively harm their patients unless they were under the supervision of a physician. With the steadily increasing number of colleagues having obtained advanced training in psychopharmacology and successfully passing the APA PEP exam, perhaps the time has arrived for shaping the discussion to be around access and inappropriate constraint of trade. The Obama Administration has begun exploring this approach from several vantage points, including that of the Federal Trade Commission (FTC).
During their consideration of the Fiscal Year 2017 Appropriations bill for the Departments of Labor, Health and Human Services, and Education, the U.S. Senate Appropriations Committee expanded an initiative started in 2016 to reduce barriers created by a lack of interstate reciprocity for occupational licenses. Additional funding was provided for consortia of States, with technical and other types of assistance from the Department of Labor, to evaluate and pursue cooperative approaches to enhance reciprocity or portability of occupational license across State lines. Such agreements would significantly ease barriers to opportunity and reemployment for thousands of Americans, especially for military spouses, dislocated workers from various industries, and transitioning service members. The Committee encouraged the Department to urge participating States to consider ways to increase their recognition of military certifications for equivalent private sector skills and occupations to further ease the transition of former service members to comparable civilian jobs. An earlier White House report made clear that this exploration should include non-physician health care scope of practice issues. Interestingly, the Administration has also reported that over the past two years 30% of new hires by the nation’s Federally Qualified Community Health Centers (CHCs) have been veterans. For those with specialized training in RxP, and especially for those who have worked with the military, the future could be quite exciting.
Making a Difference, Step by Step
Barbara Van Dahlen, President and CEO of Give an Hour, reports that they have already facilitated over 192,000 hours of free mental health care, donated by clinicians of all disciplines, to our nation’s military, veterans, and their families. A key question for psychology: Has the leadership of your State Psychological Association joined the Campaign to Change Direction? Have you personally considered Giving an Hour? Ray Folen, the new Executive Director for the Hawaii Psychological Association: “Over the last 10 years, while at Tripler Army Medical Center I had written 3,178 prescriptions and my colleague Mike Kellar had written 5,780. No adverse events.” And, President Neal Morris took seriously the challenge of actively involving our next generation in the Division’s governance by appointing USUHS graduate students Joanna Sells and Omni Cassidy as convention program co-chairs. “Serving as Division 55’s program co-chairs for the annual convention in Denver has been a very rewarding experience. As graduate students, we can feel out of place when contacting established psychologists. However, engaging colleagues as program co-chairs provided a meaningful context and purpose to developing relationships. Now we both have a greater appreciation of how valuable it is to have others respond with an enthusiastic ‘Yes,’ when asked to contribute as a discussant, presenter, or organizer. Shaping the development of a theme over time through collaboration and, in the Division’s case, interdisciplinary programming, is a great way to support the growth of psychology. As the planning winds down, we realize how many volunteer hours go into executing programming for each of the 54 divisions and Candy’s fantastic support. Discovering that this process happens each and every year is astounding!”
Pat DeLeon, former APA President – Division 55 – June, 2016