United We Stand, Divided… – by APA’s Pat DeLeon, PhD

UNITED WE STAND, DIVIDED….

Pat DeLeon, former APA President

The Critical Nature of State Associations: Early on in my career I worked for the State of Hawaii Division of Mental Health at a time when state employees were being unionized. Dues were an “expense” that I never regretted; for with the union, our collective voice was heard. A very small, but illustrative example: When the inpatient psychiatrist was going away for two weeks, he pinned a notice on the bulletin board that I was in charge. Upon his return, I submitted a request for a small amount of additional pay. The head of the Division (a physician) took the position that a non-physician could not have been in charge. The union representative successfully argued that I was, in fact, in charge — “See the pin hole where the notice was posted.” Several years later, psychologist Joe Blaylock was appointed Head of the Division of Mental Health. As individuals, we may sincerely believe that our expertise is beneficial and serves society well. However, the reality is that organized medicine has, over many years, consistently opposed any expansion of the clinical practice of all non-physicians, including their ability to serve in administrative or policy setting positions. Without developing a cohesive collective voice, the past will all too accurately continue to predict the future.

The enactment of President Obama’s Patient Protection and Affordable Care Act (ACA) heralds the beginning of unprecedented change in our nation’s health care environment. Former APA Congressional Science Fellow Sandra Wilkniss points out that the ACA provides one of the largest expansions of mental health and substance use disorder coverage in a generation. She has also urged psychology to appreciate the magnitude of transformation occurring as the nation’s health care system moves steadily towards integrated, interdisciplinary care – and thus away from its historical reliance upon fee-for-service, independent practice. Data-based gold standard “best practices” will be tomorrow’s expectation.

I sincerely appreciate the 25+ years that I have been able to be involved in the APA governance and particularly the opportunity during my Presidency in 2000 to visit a number of smaller rural state psychological associations. Nationwide, there are over 46 million citizens living in rural America who face ongoing challenges in accessing health care. Rural America is where psychology can truly make a demonstrable difference in the lives of so many Americans. Rural residents have historically struggled with issues related to access to care, recruitment and retention of health care providers of all disciplines, and maintaining the economic viability of hospitals and health care providers in isolated rural communities. Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts. Interestingly, the goal of President Obama’s “Improving Rural Health Care Initiative” is to build healthier rural populations and communities through evidence-based practices. This is an important mission for which psychology and the other behavioral sciences can make a unique contribution. Exciting opportunities exist for those with visionary leadership.

A number of our colleagues do not seem to understand that as one of the nation’s educated elite, they have a societal responsibility to become personally involved in effectively addressing society’s most pressing needs. Collectively, they do not seem to appreciate that through their own state psychological association, and at the federal level APA, they can have a profound impact upon the public policy/political process. During my involvement within the APA governance, I came to deeply appreciate that our profession is only where it is today because of the efforts of the visionary leaders of the past. Gene Shapiro, Nick Cummings, Suzanne Bennett Johnson, Bill McKeachie, and the late John Gardner (former Secretary of HEW under President Lyndon Johnson and President of Common Cause) to name just a few to whom we owe so much. Today’s challenge is for each of us to reach out to colleagues and convince them to join (and especially, to rejoin) the only collective voice they have – the Arkansas Psychological Association. This is particularly true for our senior colleagues who thereby will have the opportunity to mentor the next generation. During my early days with the Hawaii Government Employees Association (HGEA), I saw how effective this personalized approach can be. This challenge is about the very future of the field in a dramatically changing world – it is not exclusively a practitioner, academic, or science issue. It is about survival and addressing unprecedented change. It is about setting achievable goals. And it is, above all else, about taking advantage of new exciting opportunities.

Telepsychology – A Future For Many: The unprecedented advances occurring within the computer and technology fields continue to have a major impact upon all aspects of society including our economy, except, most health policy experts would proffer, the health care industry. The ACA is dedicated to rapidly changing this in furtherance of targeting the critical health policy goal of accomplishing “the triple aim” — i.e., improving the experience of care, improving the health of populations, and reducing the cost of health care. Psychology is very fortunate that 2011 APA President Melba Vasquez possessed the vision to appreciate the significance of the advent of the era of Telemental Health/Telepsychology for the profession and for all of behavioral health. Acknowledging the successes of pioneering colleagues within the Departments of Veterans Affairs (VA) and Defense (DoD) who have been particularly responsive to its exciting potential, she established in close collaboration with the Association of State and Provincial Psychology Boards (ASPPB) and the APA Insurance Trust (APAIT), a telehealth task force which systematically addressed a number of the complex issues surrounding utilizing this evolving technology. In August, 2013 at our annual convention, Council passed their recommended Telepsychology Guidelines on the consent agenda.

Telemental health services were initiated within VA in 2004-2005, and under the leadership of Antonette Zeiss, the first psychologist to be appointed chief consultant for the Office of Mental Health Services, VA was soon leading the way for the nation. In fiscal year 2013, more than 600,000 veterans accessed care using telehealth programs for a total of over 1.7 million episodes of care. It is estimated that VA telehealth services are increasing by approximately 22% annually. We are indeed most fortunate that one of the truly visionary leaders in this area is Steve DeMers, ASPPB Chief Executive Officer. His colleagues Fred Millan and Janet Pippin Orwig have been working diligently with both nursing and medicine, as well as the Council of State Governments, to coordinate developing an innovative Telepsychology Licensure Compact. The critical implementation steps will be at the state level until sufficient national consensus is ultimately developed justifying a federal approach. Working out the details will become one of the Arkansas Psychological Association’s priorities over the next several years. “It ain’t quite this simple, so I better explain just why you got to ride on the union train.” Aloha,

Pat DeLeon, former APA President – Arkansas Psychological Association – February, 2015