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The Maturation of Professional Psychology - National Perspective/Patrick DeLeon |
| Washington Update/Ron Levant | |
| Practice Directorate and MTV Launch Youth Anti-Violence Initiative/Tricia Alvarez | |
| New Developments and a New Division in Psychopharmacology/Jack Wiggins |
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The Maturation of Professional Psychology - National Perspective
Over the two and a half decades that I have had the opportunity of serving on Capitol Hill, I have particularly enjoyed watching professional psychology mature. Our numbers are dramatically increasing – at the San Francisco convention our graduate student organization (APAGS) celebrated its tenth anniversary, now possessing 64,300 members. APA has over 159,000 members and there are in excess of 81,000 licensed health care providers. However, even more important, in my judgment, has been the increasing efforts of organized psychology and individual psychologists to become personally involved in the public policy/political process. Psychology is one of the “learned professions” and it has been our observation that by “giving back” to society, we will, in turn, be well served by society’s leaders. Before The U.S. Senate — This past month we had the pleasure of watching two colleagues, Ken Winters and Tim Kelly, testify before the Senate Appropriations Committee during the hearing on Gambling Addiction. NIMH Director Steve Hyman reported on the NIH’s interest in funding “excellent science” focusing upon pathological gambling. He indicated that they would be addressing the recommendations developed by the National Gambling Impact Study Commission for longitudinal research regarding the initiation, nature, and course of youth gambling in the context of other youth behaviors and factors. Formerly the chief mental health officer for the Commonwealth of Virginia, Tim currently serves as Executive Director of the Commission. One of the witnesses that morning talked about losing $40-$50 million at the gambling table — and his subsequent sale of an NFL team. As Rod Hammond, CDC’s focal person for Youth and Violence, reflectively noted after meeting later that week with the subcommittee Chairman: “This is the bigger picture... where our colleagues must learn to focus.” A View From The Front Line — Robert Mendoza, APA Congressional Science Fellow: “It seemed like such a simple assignment. I only agreed to write a paper. The paper was to be about my almost final reflections on being an APA Congressional Fellow. Quite honestly, the assignment does not seem possible right now. The past month and next month will certainly prove to be the most active months of my tenure here in the office of Senator Bingaman. It seems impossible to think in terms of ‘wrapping things up.’” “Still left directly in my legislative sights are: The Patients’ Bill of Rights, the Substance Abuse and Mental Health Services Administration re-authorization; Labor, Health and Human Services appropriations ‘mark-up,’ and planning events for the Senator for August recess, and any and everything else that always comes up. So how does one survive such an onslaught? Keeping perspective has been important and as my colleague Dr. Ambery of the New York City police department constantly reminds me, ‘Stay in the movement.’” “The APA Congressional Fellowship has been providing these kinds of experiences since it first began in September, 1974. I am proud to have been one of 65 Fellows who traversed these legislative waters. I have had moments of excitement, boredom, confusion, and absolute rushes of adrenalin. I am certain that it will take a long time after I leave this fellowship to fully appreciate the effect this has had on my personal and professional life. So, what is this program really about?” “The APA Fellowship enjoys an outstanding reputation on Capitol Hill. Offices who have had fellows have given fellows very high marks and offices always search for APA fellows year after year. The fellows, like APA itself, represent diverse training and professional experiences. Differences in personality amongst the fellows themselves also become magnified while on the Hill. If you listen to the experiences of APA fellows, it is hard to believe that they are part of the same program, as their Hill experiences are so different from one another. There is, however, one aspect that fellows seem to have in common. APA fellows have carried out a long tradition of NOT being or feeling beholden to APA in any particular legislative or political manner. It is exactly this kind of independence from APA that Hill offices appreciate almost as much as the fellows’ general competence and professional experiences.” “I suppose APA, like other professional societies that support Capitol Hill fellowships, wrestle with the question of ‘What does APA really get for it’s money?’ It’s a valid question. APA could certainly spend its fellowship money in just about any other governmental affairs programs and could get more bang for the buck. So why do it? I am not sure that any of the 65 previous fellows could tell you exactly why. Let me share my reasons why I think APA has done well to continue the fellowship program.” “Late last week, I was walking back from the Capitol with Senator Bingaman. We were returning from a Members meeting on the Patients’ Bill of Rights. As we strolled by the gardens at the Capitol, I asked the Senator how he thought the meeting went. He smiled and asked me how I would be spending my August vacation. At first I was confused why he had not answered my question and then I realized something else. If you can learn perspective on Capitol Hill, you have learned something valuable and rare that can be shared anywhere. Hopefully there are 65 of us that are, or will be, doing just that wherever we go.” Before The U.S. House Of Representatives – Judith Albino is currently President of the California School of Professional Psychology (CSPP). Prior to assuming this position, Judith was President of the University of Colorado and served as Treasurer of APA. During my years of involvement within the APA governance, I have come to appreciate how serving on the Board of Directors provides one with a qualitatively different perspective of psychology’s maturation and potential contributions to society, a vision that is simply unsurpassed by any other experience. It also provides an intimate appreciation for how much we really are all one family — science, practice, education and public interest. Testifying this April before the House Appropriations Committee, Judith highlighted the importance of distance learning and telehealth to psychology and to our nation: “CSPP graduates more than half of the psychologists educated in California, and nearly 20 percent of psychologists educated in the United States. CSPP trains 2,300 students annually, about 20 percent of whom are ethnic minorities. In addition to our headquarters in San Francisco, CSPP has four campuses across the state of California in San Diego, Los Angeles, Fresno, and Alameda....” “As part of its strategic plan for the next century, CSPP plans extensive growth in telehealth educational and clinical services. We have adopted this strategic plan as it supports our mission of finding new ways of serving underserved populations. We are talking with potential partner organizations, such as the California Department of Corrections and the Department of Developmental Services, and exploring the possibility of providing direct psychological care via telehealth to their populations, as well as delivering custom-designed training programs for personnel working in those agencies. It is our goal to share more broadly what we already have in great abundance: psychological expertise; experienced care givers, supervisors, and teachers; and graduate students eager to learn and to practice.” “In addition, CSPP is in the process of adding videoconferencing facilities at each of its campuses, in order to provide updated training for mental health practitioners throughout California and the U.S. For example: we launched a new post-doctoral Master’s degree in Clinical Psychopharmacology, using distance learning technology to assist licensed professionals in updating their skills as they work with patients who are on medications, and collaborate with primary healthcare practitioners in the management of these cases....” “Telehealth practices can expand the delivery of behavioral and mental health care services, making it available in places where access is problematic. The time has come – certainly the technology has been developed – to leverage behavioral healthcare resources and make them widely available by overcoming geographic and other barriers.” [Interestingly, we were recently informed by the Hawaii State Primary Care Association that the Harry and Jeanette Weinberg Foundation will be providing the association and each community health center in the state with $200,000 to procure telemedicine equipment and services. The previous year the foundation provided similar support to link various hospitals in Hawaii via telemedicine.] Another Vantage Point. Another Perspective – Current APA Board member Norine Johnson and her work on “Adolescent Girls: Valuing Strengths and Valuing Diversity in Psychotherapy:” On May 24th the Supreme Court ruled that school districts can be liable for damages for failing to stop a student from subjecting another to severe, pervasive, and objectively offensive sexual harassment behavior. For psychotherapists working with adolescent girls and knowing that persistent sexual harassment frequently is the precursor of depressive symptoms, we welcome the support of our highest court. This is but one of the public policy changes and crises in our culture that make it a crucial time for psychologists with psychotherapeutic and consultative skills to be working with teens, their parents, their schools, and their communities. “As a result of my work as co-chair with Division Past-President Karen Zager of the APA Task Force on Adolescent Girls, I have adapted my therapeutic interventions to focus on valuing diversity and building strengths in girls, their families, and their communities. The adolescent population in the United States is growing rapidly and will continue to grow into the next millennium. These adolescents and their families need the type of services psychologists can deliver. Concomitantly, the percentage of racial and ethnic minorities is increasing. Approximately one third of the 18.5 million adolescent girls (ages 10-18) [e.g., 6 million racial and ethnic minority girls], were living in the United States at the last census in 1990. It is of vital importance that we become knowledgeable about the ethnic and class cultures in our clients’ communities. For over a decade researchers began to challenge the accuracy of the stereotype of an inevitable, problematic adolescence. Findings in the National Longitudinal Study on Adolescent Health identified key protective variables to adolescent health – empathetic relationships with parents and connected relationships with adults in the schools. There are innumerable examples of effective programs developed by psychologists. The time has come for public policy to recognize and fund ways to assist adolescents today. Using current research, here are five key points with therapeutic implications that I have found helpful to adopt in my work with adolescent girls: 1) Girls from different ethnicities, races, and classes use different standards to judge themselves and have different strengths. 2) Connectedness and empathetic relationships with parents, school personnel, and ‘other mothers’/ ‘other fathers’ are the key variables for the development of healthy teens. 3) A sense of competency and the development of problem solving skills are critical for the development of a healthy and resilient self. 4) Positive body images and awareness of gender issues in a girl’s environment enhance her self-esteem. And, 5) The ability to be outspoken in relationships promotes strength and resiliency.” “I invite psychotherapists to consider expanding their services to teens and to consider incorporating into their treatment approaches those aspects from the current research that support a focus on valuing strengths and diversity. For those interested in learning more about this topic, the Adolescent Girls’ Task Force book, Beyond Appearance: A New Look at Adolescent Girls, was recently published by APA.” The Prescription Agenda: Progress At The State And Educational Levels – STATE AGENDAS: Elaine LeVine of the New Mexico Psychological Association Task Force reports that: “Efforts to support prescription privileges for psychologists in New Mexico have been evolving strongly over the last several years. A survey completed in 1998 by the Task Force on Prescriptive Authority of the New Mexico Psychological Association revealed that 65 percent of the psychologists who responded strongly supported prescription authority. This figure from the rural state of New Mexico aligned closely with findings from the APA’s national study and from surveys completed in the more urban states. On June 5, 1999 the New Mexico Psychological Association voted to endorse prescription authority and to work closely with its Task Force on Prescription Authority to present a bill before the legislature in 2001. In addition, coursework has been established within the state, building upon materials and expertise provided by the Prescription Privilege Register (PPR) and statewide experts. There are plans to incorporate coursework in pathophysiology offered through the Nursing Department of New Mexico State University. Further, the University has expressed interest in integrating this coursework into a formal program of postdoctoral study. Twenty licensed psychologists in New Mexico have embarked upon this study of psychopharmacology to better assist their patients, with the goal that psychologists will gain prescriptive authority in New Mexico in the near future.” Educational Initiatives: This June I had the distinct pleasure of participating in the annual meeting of the Florida Psychological Association where, under the visionary leadership of FPA President Nancy Bacher, the University of Florida and NOVA Southeastern University announced the establishment of innovative prescriptive authority training modules targeted specifically towards licensed practitioners in the state. This exciting development was clearly an outgrowth of impressive University-FPA leadership collaboration. The theme of the FPA annual convention: “Entering the New Millenium: A Step Ahead.” APA Recording Secretary and Dean of the Center for Psychological Studies at NOVA Southeastern University, Ron Levant, reports on Psychopharmacology Training for Practicing Psychologists leading to a Postdoctoral Masters Degree in Psychopharmacology: Several months of planning between the Florida Psychological Association (FPA) and the Center for Psychological Studies (CPS) at Nova Southeastern University has resulted in the implementation of a rigorous, high quality curriculum taught in cooperation by faculty of the Center, faculty within the Health Professions Division and the medical staff at our Community Mental Health Center (CMHC). This curriculum is based upon a model developed by a Blue Ribbon Task Force composed of national experts in psychopharmacology, including physicians, psychiatrists, Department of Defense Demonstration Project prescribing psychologists, neuroscientists, pharmacists, and nurses who developed a framework for training psychologists in psychopharmacology. In 1995, the APA formally adopted and approved (with minor alterations) this curriculum as a national model for psychopharmacology training for practicing psychologists seeking additional credentialing as “prescribing psychologists.” This training is now being implemented in numerous states around the country. “The overriding philosophy and rationale for the FPA/CPS coordinated curriculum is based on a ‘psychology model.’ Training is respectful of the unique training of psychologists and their broad, comprehensive background and expertise as diagnosticians, researchers and clinicians in the mental health arena. Training is consistent with psychologists’ broadly humanistic tradition and biopsychosocial orientation in contrast to a strictly medical model, which stresses biological interventions for psychological problems. In this training, prescribing is viewed as one tool among many psychotherapeutic interventions available, augmenting the broad array of treatment approaches psychologists are trained to use.” “TRAINING - The first class of licensed psychologists should begin training in September, 1999. The program is designed so that practicing psychologists will have their professional life disrupted minimally. The curriculum includes 395 hours of university-based didactic course work with an appropriately interspersed 200 additional hours of supervised clinical practicum. The program is structured to be completed in two years. Classes are held once per month on Friday, Saturday, and Sundays for nine months. Practica are arranged individually during the summer months for training at the Nova Southeastern University Community Mental Health Center. Students upon completion of their practica will have had contact with a minimum of 100 patients who are on medication. The CMHC will serve as the primary clinical training site with the CMHC psychiatrists serving as supervisors and educators.” “Graduates of this program will be prepared to demonstrate competence in nationally accredited examinations in psychopharmacology. The APA College of Professional Psychology is in the process of completing such an examination. This could lead to an APA designation of proficiency in Psychopharmacology.” “When Florida passes legislation which enables psychologists to prescribe, our graduates should definitely meet the criteria for eligibility. In the mean time, students completing this program will be able to discuss intelligently with their patients’ medical doctor or primary health care practitioner whether psychopharmacological interventions are necessary. Prerequisites:
The Committee was chaired by A. Eugene Shapiro, who will serve as coordinator of the program. Special thanks to Nancy Bacher, President of FPA, for all her assistance and collaboration.” Does Organized Medicine Really Care? We Would Suggest, “Yes” – A colleague from California recently shared with us a copy of a letter he received from the California Psychiatric Association (CpA): “June, 1999 — Dear Colleague, Three years ago California leaders of organized psychiatry appealed to all psychiatrists in the state for funds to help fight both legislative and initiative battles threatening the welfare of our patients, the way we practice psychiatry, and, in the final analysis, the survival of our profession. Due to your generous commitment to our patients and our profession, that appeal was successful in creating the nidus of an Educational Fund. The funds were critical to our success in educating legislators about psychiatric issues and the needs of our patients. We effectively stopped several psychologist-sponsored bills designed to broaden their scope of practice, including prescribing.” “The California Psychiatric Association will enter the next millennium again facing legislative crises, but with an exhausted Educational Fund. We are outnumbered and out-financed by the psychologists and many of our membership are not in a position to afford higher dues or an assessment. Therefore, we have again established a Psychiatric Education Fund, the resources of which will be used to educate the legislature, the public and the media as to the importance of psychiatric issues, the care of our patients and the dangers of proposals for prescribing by psychologists. We understand that many psychiatrists, for reasons of their own, choose not to belong to the CPA or the APA. The issues, however, as much as any we have ever faced, affect all psychiatrists.” “Pat DeLeon, PhD, Chief of Staff for Senator Daniel Inouye (D-HI) who introduced the Department of Defense Demonstration Project that trained military psychologists to prescribe psychotropic medications), was elected President-elect of the American Psychological Association and will take office in January 2000. He is a shrewd, combative adversary who will continue to battle for psychologists prescribing privileges. Buoyed by their supervised prescription privilege victory in Guam, the psychologists will next target sparsely populated states such as Alaska and rural states such as Georgia and Louisiana in an effort to build momentum for the struggle in California. We are expecting a psychologist prescribing bill in California in the year 2000.” “In just the first three months of this year, psychologists in California voluntarily contributed over $35,000 to their political action committee. Realizing the effectiveness of our key contact system, the psychologists are now attempting to emulate it. ‘In the next three years, we’ll see the first state gain (prescription) privileges,’ DeLeon predicts... ‘In a decade, all states will give psychologists the right’....” [Signed by 11 of CpA’s elected leadership.] As goes California, goes the rest of the nation. Yet, neither my son nor daughter believe that I am such the “public health hazard” that they allege, at least not on the basketball court nor the soccer field.” A Critical Future Focus: As we reflect upon the impressive developments occurring across the country on behalf of the prescription agenda, we must never forget the “Foxism:” “Psychologists are very good at circling the wagons and then shooting in.” APA Board member Ruth Paige has stressed the critical importance for those of us supportive of the prescription agenda of ensuring that those colleagues selected to serve on the various state and provincial psychology boards become personally comfortable with embracing APA policy. It has unfortunately been evident that many of these individuals are personally not as supportive of the prescription agenda as one might wish. To cite several concrete examples. During legislative hearings, the then-chair of the Hawaii board was “less than enthusiastic,” notwithstanding HPA proactive position. After introduction of prescriptive legislation in Alaska, their psychology board seems to require extensive deliberations to solidify their position. In New York, Dennis Alne is professionally interested in furthering the preventive healthcare revolution. Logically, this could involve weight-loss programming, particularly utilizing cognitive-behavioral procedures. After being informed by the State Board for Nutrition and Dietetics that anyone can recommend natural supplements, the State Board for Psychology suggested that psychologists may not even discuss the pro’s and con’s of medications with patients. And it warned that discussions about natural products could be viewed as being within the providence of medicine; thus, perhaps representing professional misconduct. Hardly supportive of our profession systematically “expanding our professional boundaries,” nor reflective of the monumental changes towards patient control and accountability (the foundation of alternative medicine) which is exploding throughout our nation’s health care system. |
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| Patrick DeLeon, Ph.D., J.D. | ||||
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