Pat DeLeon, former APA President – Hawaii Psychological Association

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Toronto is a beautiful city and the weather was nearly perfect. In between sessions, it was possible to wander through historic neighborhoods and, for example, Canada’s Walk of Fame highlighting actors, musicians, outstanding hockey players — such as Maurice “Rocket” Richard and Gordie Howe — as well as inventor Alexander Graham Bell. The home of the Hockey Hall of Fame – and the Stanley Cup — where the APA Presidential Reception was held on Saturday evening. Division 42 President June Ching hosted an outstanding program (and social hour). University of Hawaii graduate and former East-West Center fellow Laura Corlew shared her American Psychological Foundation (APF) visionary grant accomplishments in addressing risk perception regarding natural disasters and climate change in Hawaii and American Samoa. Laura is one of several grantees that donors to APF make possible. APF is in the middle of the Campaign to Transform the Future to increase its grant-making capacity. Although APF grants approximately $800,000 annually, the Foundation can only support 10% of those who apply. It is the Foundation’s hope that with this Campaign no worthy graduate student or early career psychologist will go without needed support.

The APA Council of Representatives: Council spent a considerable amount of time discussing and responding to the Hoffman report. President-elect Susan McDaniel and Past-President Nadine Kaslow reported “The Council voted overwhelmingly to prohibit psychologists from participating in military and national security interrogations that operate outside the protection of the U.S. Constitution and military law. The measure passed by a vote of 157-1, with 6 abstentions and 1 recusal…. The prohibition does not apply to domestic law enforcement interrogations or domestic detention settings where detainees are under the protection of the U.S. Constitution….”

A number of important measures were passed, including one responding directly to the emphasis of the Affordable Care Act (ACA) on capitalizing upon the unprecedented developments occurring within technology in order to provide the highest possible quality of evidence-based health care. Specifically, Steve DeMers, CEO of the Association of State and Provincial Psychology Boards (ASPPB), reported that Council endorsed their Psychology Interjurisdictional Compact (PSYPACT) “to facilitate telehealth and temporary face-to-face practice of psychology across jurisdictional boundaries.” APA governance and the general membership had the opportunity to review this proposal. The Board of Professional Affairs (BPA) proffered that PSYPACT “would effectively facilitate telepsychology practice described in the APA Guidelines for the Practice of Telepsychology (APA, 2013) as developed by the Joint Task Force for the Development of Telepsychology Guidelines, comprised of representatives from the APA, ASPPB, and the APA Insurance Trust (APAIT).” That task force was co-chaired by Linda Campbell and Fred Millan, with the active participation of Trust CEO Jana Martin.

ASPPB President Martha Storie noted “The PSYPACT will promote further cooperation and standardization of requirements among psychology licensing boards, and consequently, will serve to protect consumers of psychological services.” An interstate compact is an agreement between states to enact legislation and enter into a contract for a specific, limited purpose or address a particular policy issue. They are unique in their duality as statute and contract. ASPPB will be working with the Council of State Governments (CSG) to create a resource kit that will serve as an informational document in support of this development. The Compact will standardize practices that are currently jurisdiction-specific such as: (a) how many days of face-to-face practice are permitted in a state where the psychologist does not hold a license; and, (b) credentialing and authorization to practice telepsychology from an identified “home” state with a client in a state that has joined the Compact. The PSYPACT would need to be adopted by state legislatures; the Compact would establish further rules and regulations regarding interjurisdictional practice.

Steve reminded me that the compact approach psychology is developing is conceptually very similar to that being proposed by professional nursing (adopted by 25 states) and organized medicine (currently 11 states with more expected over the next year), with physical therapy and EMTs also exploring this approach. ASPPB had received a grant from HRSA to facilitate their efforts to effectively address licensure mobility; telepsychology representing one aspect of this larger vision. Change always takes considerable time and as the various health professions experiment with their implementation and political details, modifications will undoubtedly evolve. In Toronto, I was particularly pleased to see Deborah Baker, Ken Drude, and Marlene Maheu continuing their impressive efforts to educate the grassroots membership. Ken chaired the Ohio Psychological Association committee that developed the first psychological association telepsychology guidelines back in 2008.

The Obama Administration: In July, the White House released its report Occupational Licensing: A Framework for Policymakers, which was prepared by the Department of the Treasury Office of Economic Policy, the Council of Economic Advisers, and the Department of Labor. Fundamental issues surrounding the licensure of health care professionals were addressed throughout the report, including licensure mobility and variations in professional scopes of practice within the states. “While quality can be defined in many ways and is often difficult to measure, the evidence on licensing’s effect on prices is unequivocal: many studies find that more restrictive licensing laws lead to higher prices for consumers.” “(S)ince each State sets its own licensing requirements, these often vary across State lines, and licensed individuals seeking to move to another State often discover that they must meet new qualifications (such as education, experience, training, testing, etc.) if they want to continue working in their occupation.” “Licensing reform takes place at the State level, but Federal resources can help to incentivize State collaboration.”

The White House reported increasing review at the State level of health care scopes of practice in a more comprehensive manner, citing California, Colorado, Pennsylvania, New Mexico, and Minnesota. “Connecticut’s State legislature conducted a particularly thorough 2009 review of scope of practice for the health care professions, including comparisons with regulatory models from other States.” And, “According to the Pew Health Professions Committee report in 1995, policymakers should endeavor to allow practitioners to offer services to the full extent of their competency and knowledge, even if this means that multiple professions are licensed to offer overlapping services.” Enumerating Licensing Best Practices, the report urged States to: “Ensure that Licensing Restrictions are Closely Targeted to Protecting Public Health and Safety, and are Not Overly Broad or Burdensome.” “Scope of practice has long been a particular focus in the health care context, in large part because of concerns about access to primary care. Current scope of practice laws for advanced practice registered nurses – nurses such as nurse practitioners (NPs) with master’s degrees or more – vary dramatically by State, both in terms of their substantive content and the level of specificity that they provide. But State-level evidence suggests that easing scope of practice laws for APRNs represents a viable means of increasing access to certain primary care services. Research finds that APRNs can provide a broad range of primary care services to patients as effectively as physicians.” This movement has even expanded to the legal profession with the Supreme Court of Washington State adopting a rule in 2012 creating a new category of legal practitioners – limited license legal technicians (LLLTs). The key for psychology is: “Who is having this dialog?” Fundamentally, they are national/international experts who are passionately interested in our nation’s financial future; not individuals who are vested in their own profession’s status.

Dramatic change is coming to our nation’s health care environment and psychology is well positioned for the future. A closing reflection — I was very pleased to see the standing ovation which Steven Reisner and his colleagues Stephen Soldz and Jean Maria Arrigo received at the Toronto Town Hall meeting addressing the Hoffman report. Well-deserved tributes. Aloha,

Pat DeLeon, former APA President – Hawaii Psychological Association – September, 2015