The November elections are finally over and the nation has spoken. The time has come for us to collectively establish a new sense of direction and focus for the future. I recently had the exciting opportunity, in my capacity as former APA President, of visiting with two university training programs. The enthusiasm and sense of purpose which existed among the students was very impressive. I begin to wonder, however, if our educational institutions truly appreciate the magnitude of change that they are facing in preparing our next generation of colleagues for the education and health care environment of the 21st century, as well as the critical importance of instilling a sense of social responsibility. Cynthia Belar, Executive Director of the APA Education Directorate, understands that “bigger picture” and in my judgment, has very nicely begun to systematically provide the necessary foundation. Institutional change is always surprisingly unsettling for many.

“The APA Education Directorate has been very active in encouraging advocacy on the part of faculty, supervisors and students. Under the auspices of the Board of Educational Affairs, a Sample Curriculum for Advocacy Training was developed that can be adapted to local program needs (http://www.apa.org/ed/sample_home.html). Education Directorate public policy staff have also conducted numerous advocacy training workshops at APA conventions and Education Leadership Conferences (ELC). In addition, a number of focused workshops have been provided for members of the American Psychological Association of Graduate Students (APAGS), the Council of Chairs of Training Councils, the National Council of Schools and Programs in Professional Psychology, the Association of Counseling Center Training Agencies, the Council of Counseling Psychology Training Directors, and the Association of Psychology Postdoctoral and Internship Centers. Nina Levitt and I speak to related issues at nearly every meeting we attend, since grassroots participation is essential to our work. We started our Federal Education Advocacy Coordinators network on a 10 region basis, and now have Campus Training Representatives at well over 200 academic institutions and training sites across the country. This year we were successful in establishing the Education Advocacy Trust to permit the full range of activities fundamental to the advocacy process.

“In September, as part of the ELC, more than 60 leaders went to Capitol Hill to advocate for two items on the Education Directorate’s appropriations agenda: the APA initiated Graduate Psychology Education (GPE) program and the Garrett Lee Smith Memorial Act, of which APA and its members drafted key provisions. Since the inception of these two programs just a few years ago, over $24 million has gone to more than 108 institutions of higher education (counseling centers or psychology training clinics) or psychology doctoral, internship or postdoctoral programs to train health service psychologists to work with undeserved populations or to facilitate behavioral health services on campus. These programs have benefited not only the education community, but practitioners and related research efforts as well. Both programs also highlight how APA and its members can make a real difference in national policy, and how we need the involvement of our community in order to be successful. In the words of one ELC attendee: ‘I thought the (advocacy) training was hokey... until I got up on Capitol Hill.’”
Over the years, it has been evident to those of us who have worked on Capitol Hill that many of our colleagues are simply not comfortable in viewing themselves as “social change agents” and, in all candor, do not feel that they know how to become effectively involved. The world of politics (with its own language and rules) has not been an integral component of our training experiences. Accordingly, we were particularly pleased that Nadia Hasan of the University of Akron will Chair APAGS during the coming year. Nadia’s platform called for the increased involvement of our next generation in the public policy process – thereby, controlling their own destiny. And as a result, obtaining that all important “hands on” experience that will give them a personal sense of the “art of the possible.” During her campaign for the APA Presidency, Katherine Nordal talked about the need for APA publishing a public policy textbook targeted towards our next generation. As APAGS and our educational leadership become more intimately involved, Katherine’s vision will undoubtedly become reality.

Nadia: “One of my initiatives is to empower graduate students with knowledge about emerging issues in psychology such as the use of technology, prescription privileges (RxP), and globalization. I feel it is important for graduate students to know more about RxP. I hope that we can educate students and perhaps motivate them to advocate for this clinical authority within their state psychological associations. Psychology graduate students are the future of psychology! Currently, there are over 40,000 student members making us a large constituency within APA. As students we have unique needs and perspectives.... I shall: * Listen to the diverse and unique voices of graduate students regarding training issues. * Empower graduate students with knowledge about emerging issues in psychology such as the use of technology, prescription privileges, and globalization. * Advocate for our collective needs as graduate students within APA and on the state and federal levels, with respect to issues such as licensure requirements, research funding, internship availability, and graduate school funding. [And] * Promote diversity among APAGS members and throughout graduate training.” By becoming involved in the public policy process our future will hopefully begin to understand their societal responsibility, as members of a “learned profession,” to provide proactive and visionary leadership, rather than passively respond to agendas established by those who simply do not understand psychology’s potential contributions to society’s pressing needs.

Former APA Practice Directorate State Advocate Mike Sullivan has often noted that our prescriptive authority agenda (RxP) has the most political traction in those areas of the nation that are truly under served and possess the least desirable health, education, and social-economic statistics. In our judgment by seeking to serve society, in the long run professional psychology will be well served by our nation’s elected officials. In New Orleans, I urged those looking to establish “hands on” RxP practica to explore developing relationships with their own community health centers. Hawaii’s RxP efforts are based upon practicing within health centers and has the enthusiastic support of each of their medical directors. One of the issues raised during my university visits was the perceived shortage of internship sites for senior graduate students. Thus, the e-mail which former Hawaii Psychological Association President Kate Brown recently shared with her colleagues made me wonder:
“Funding Opportunity for Mental Health Providers Committed to Working with Under served Populations – Vacancies in the National Health Service Corps Loan Repayment Program (NHSC LRP). The NHSC LRP continually seeks clinicians dedicated to working with our nation’s undeserved There are currently over 150 vacancies listed for clinical psychologists across the country. For additional information on this NHSC vacancy and other opportunities, visit http://nhsc.bhpr.hrsa.gov/jobs/search_form.cfm. Approximately 50 million people live in communities without access to primary health care. The National Health Service Corps (NHSC) is working to change this by helping medically undeserved communities recruit and retain primary care clinicians, including mental and behavioral health professionals, to serve in their community. In the 30 years of the NHSC’s existence, over 24,500 clinicians have been recruited to serve medically undeserved populations through their programs. Currently, there are over 3,900 clinicians serving commitments to the NHSC. However, the NHSC seeks additional clinicians committed to working with undeserved populations.

“The NHSC Loan Repayment Program (LRP) is one way the NHSC works to unite communities in need with caring health professionals. This federal program makes contract awards to clinicians that agree to serve full time for two-years at approved sites in designated health professional shortage areas (HPSAs) of greatest need. In return for this service, NHSC LRP participants receive money to repay qualifying educational loans that are still owed. Maximum repayment during the required initial 2-year contract is $25,000 each year with the possibility of extension of service and loan repayment at $35,000 per year. In addition to loan repayment, clinicians receive a competitive salary and a chance to have a significant impact on a community. To be eligible for the Loan Repayment Program (LRP), you must be a fully trained mental or behavioral health professional (e.g., health service psychologist). Loans qualifying for repayment include government (Federal, State, or local) and commercial loans obtained by the participant to pay for school tuition, required fees, and other reasonable educational and living expenses incurred by the participant for undergraduate or graduate education leading to a health professions degree....

“Another way the NHSC works to improve the health of the nation’s undeserved is through the Ambassador Program. The NHSC Ambassador Program is a membership organization comprised of volunteers, representing the NHSC eligible health professions, on campuses and in communities across the nation. Ambassador activities focus on four areas: recruitment/retention, preparation/training, mentoring, and advocacy. The NHSC is currently recruiting Campus and Community Ambassadors in the areas of clinical or counseling psychologists. The Ambassador program provides a unique opportunity for psychologists committed to working with undeserved populations by extending their roles to guiding future practitioners in this area and gaining advocacy skills to highlight the importance of this work. For additional information... on becoming an Ambassador, visit http://nhsc.bhpr.hrsa.gov/ambassadors/index.asp.” We would rhetorically ask: What better contribution (or role) could our State Associations have as we enter the 21st century? We understand that each of the Armed Services are also having difficulty in filling their psychology slots. Shouldn’t our profession’s educational institutions have a significantly greater presence in developing training locations; especially, for example, within those 3400+ community health centers, initiated during President Johnson’s War on Poverty?

During his New Orleans Presidential Address, long time RxP advocate Gerry Koocher cautioned our future generation: “Advances in psychopharmacology and the demonstrated effectiveness of prescribing psychologists, with appropriate post-doctoral training, signal the end to any claims of uniqueness or incremental quality by medical providers trained in the traditional psychiatric model.... As psychologists with post-doctoral credentials in psychopharmacology grow in numbers, and the aging population of baby-bloomer psychiatrists retire, psychiatry will disappear as a medical specialty. The hazard facing us will involve avoiding the pitfalls that 20th century psychiatry ignored. We must guard against potential loss of competence in the skills that have traditionally offered our clients incremental value: our scientific foundations in assessment, psychotherapy, and other non-medical interventions. Reaching for a prescription pad is easier than conducting a well founded assessment and expert psychotherapy. The demands of the marketplace may make it more lucrative to prescribe than to talk.”

In all candor, I keep wondering whether our next generation of colleagues (and more importantly, today’s teaching institutions) truly appreciate the importance of addressing society’s pressing needs. Why don’t we more often hear about initiatives established by our professional schools which are expressly designed to reach out to the community health center population? As the proud father of two AmeriCorps participants, I was intrigued to learn that the National Association of Community Health Centers, Inc. (NACHC) launched a Community HealthCorps initiative in 1995 to bring national service resources to community health centers, primary care associations, and clinic consortia that provide primary health care to residents of medically undeserved areas. Today over 600 Community HealthCorps members serve in 33 partner organizations at over 100 delivery sites across 18 states, Washington, DC, and Puerto Rico. These HealthCorps members serve both in rural and urban areas, meeting the needs of migrant farm workers, the uninsured and under insured, and homeless individuals. During the first decade of the program, 2,500 HealthCorps members provided: * over 411,150 outreach and case management encounters; * over 321,230 patient encounters to improve utilization of health care services through education and self-management efforts; and, * over 170,500 patient encounters to link patients with other health and social services (e.g., housing, employment, and child care) provided by other agencies and organizations in the community.

HealthCorps members (generally serving in teams of 8-15) are part of the AmeriCorps network of community and national service programs engaging more than 75,000 Americans annually in intensive service to meet critical needs in health and human needs, education, public safety, homeland security, and the environment. These dedicated citizens receive a living allowance, health insurance; and if eligible, child care benefits. One of my daughter’s colleagues remarked after receiving her first paycheck: “Now I know what volunteering really is!” After completing their term of service, each full-time participant receives an educational award of $4,725 to be used towards student loans or future education costs. Over 80 percent of HealthCorps members express interest in pursuing careers in the health professions. We would rhetorically ask: Would not a program like HealthCorps be an excellent vehicle for our educational institutions to provide meaningful mentoring services and from which to actively recruit our future generations?

A New Direction For Psychology? One of the underlying tenants of the 21st century will be individually focused, scientifically based, “gold standard” care. On December 1, 1999, then-First Lady Hillary Rodham Clinton stated: “Ask any young parent whom they turn to first with questions and concerns about their children, and they’re likely to answer, ‘The pediatrician.’ When our children are young, many of us call the pediatrician at the first sign of a sniffle. We rely on them to calm our anxieties about the full range of complaints – from colic to chicken pox, bronchitis to boyfriends. Last month, with overwhelming bipartisan support, Congress passed the Children’s Hospitals Education and Research Act... (which) will provide long overdue financial support to the very institutions – the children’s medical centers and teaching hospitals – that are the most important training facilities for our children’s doctors.

“In an increasingly competitive health-care market, dominated by managed care, teaching hospitals struggle to cover the significant costs associated with training and research. While other teaching hospitals receive support for these costs through Medicare [GME], children’s hospitals receive virtually no federal funds, even though they train 30 percent of the nation’s pediatricians and nearly 50 percent of all pediatric specialists. In many cases, they provide the regional safety net for children, regardless of medical or economic need, and they are the major centers of research on children’s health problems. Millions of American children each year are treated by physicians affiliated with or trained in one of 60 independent children’s hospitals across the country. As I have traveled around the country over the past 25 years, I have had the opportunity to become acquainted with the valuable services many of them provide....

“Earlier this year, I invited a group of senior children’s hospital administrators to the White House to discuss the burdensome costs of graduate medical education. A typical independent children’s teaching hospital receives less than 1/200th, or .005 percent, of the Medicare graduate medical education support that other teaching hospitals receive. This inequity is only exacerbated by the fact that these centers face the additional costs of serving the poorest, sickest and most vulnerable children, as well as conducting research that benefits all children.

“That day, I was pleased to announce that, in order to address this issue, the President would earmark $40 million in his FY2000 budget plan to provide federal financing of graduate medical education for freestanding children’s hospitals. On average, hospitals could receive nearly $10,000 per resident, or almost $700,000 for each facility. We worked tirelessly to win these funds, and were extremely pleased that Congress authorized them in the budget agreement. When the President signs the Children’s Hospitals Education and Research Act, we will have taken an important first step towards putting children’s teaching hospitals on an even footing with other medical education centers – a critical investment in a healthy future for all our children” [Now, Public Law 106-310]. Today the annual funding for this program approximates $300 million. Will psychology’s educational institutions seek recognition under this important initiative? Shouldn’t we seek to ensure that our nation’s Children’s Hospitals have access to pediatric psychologists?

Aloha,
Pat DeLeon, former APA President