FROM THE APA DIVISION 55 LISTSERV:
The Prescriptive Authority Agenda In our last column we
reported that: During the last legislative session, the Hawaii
Psychological Association, in collaboration with the Hawaii Primary
Care Association, nearly obtained prescriptive authority (RxP) for
their members working within federally qualified community health
centers. The resulting legislatively mandated RxP Task Force was a
major accomplishment. Louisiana Psychological Association President
Jim Quillin stressed that: the medical in medical psychology is an
adjective that modifies rather than defines who and what we are
psychologists. Ray Folen is a member of the Hawaii RxP Task Force.
His report on their first meeting this October:
The first meeting of the legislatively mandated RxP Task
Force started with a parking lot encounter with the anti-RxP
psychiatrist assigned by organized psychiatry to represent them
during the discussions. He greeted me with an obvious dig So what
do you guys do? Testing, right? I didnt offer him the courtesy of
a reply as we walked to the State Capital for our meeting with the
legislators chairing the task force. One thing was clear, though: he
was feeling threatened. My colleagues and I knew he confided in
others that it was only a matter of time before psychologists had
prescriptive authority. His job was to stave off the inevitable as
long as possible. I might have felt some sympathy for his situation,
were it not for the fact that he had little to offer in the face of
the desperate need for mental health services in our state. We, like
most areas of the country, have a critical shortage of psychiatrists,
particularly in rural and underserved areas and we have a desperate
need for pediatric psychiatrists in particular. Inpatient adolescent
units have had to close due to a lack of psychiatrists.
Is there any chance they will be able to improve this
situation in the future? The answer is a resounding No.
Psychiatry residencies have to pull 40% of their residents from
foreign countries due to a lack of U.S. applicants. Only three
percent of psychiatry graduates have plans to work in rural or
underserved areas. Hawaii psychologists, on the other hand, can be
found in almost all areas of the state. A large percentage are
providing psychological services to children. Psychologists are
found in most of the federally-designated community health centers
(CHCs), whose charter is to provide services in underserved areas.
The CHC psychologists work collaboratively with the primary care
physicians to provide their patients with appropriate therapy and
adjunctive pharmacological interventions when needed.
Prescriptive authority is only meaningful in appropriate
context, and the primary care psychology model is one that makes the
most sense to us. Primary care psychologists work in a primary care
clinic. They provide traditional behavioral health services (e.g.,
treatment of depression, anxiety, substance abuse), as well as more
specialized behavioral medicine services (e.g., treatment of obesity,
high blood pressure, diabetes, headache). In our experience, family
practitioners welcome psychologists in their clinics. These
psychologists not only provide an opportunity for the immediate
referral of the distressed patient, but also provide truly
comprehensive treatment in the primary care environment. The
patients welcome the seamless continuity of their overall health care
and appreciate the lack of stigma that has been historically
associated with behavioral health care. Additionally, insurance
companies are beginning to realize that services provided in this
manner are leading to a reduction in overall healthcare costs.
Many primary care psychologists (almost all of those in
Hawaii) have received additional training in psychopharmacology.
This is particularly valuable as psychologists are often the sole
behavioral health provider in our rural clinics. Over the last
several years, the primary care providers, with an average of six
weeks of mental health training and limited formalized
psychopharmacologic education, have come to rely on our expertise and
that of nurse practitioners in this area. It is noteworthy that the
CHC medical directors wrote a letter to the state legislature
endorsing prescriptive authority for psychologists last legislative
session.
This scenario could be repeated in other places.
Federally-qualified CHCs can be found in every state. Primary care
psychologists have clearly demonstrated their proficiency in this
venue and it is imperative that we continue to do so. As more
psychopharmacology-trained psychologists provide services in the
primary care environment, it will offer an increasingly convincing
argument for the value this expertise provides to our patients and
our communities alike. Unlike some of our psychiatric colleagues, we
have begun to respond to the behavioral health care crisis by
walking the walk, not simply talking the talk.
Our sincerest congratulations to Jill Oliveira-Berry and
Robin Miyamoto for their success in obtaining and maintaining active
support throughout the legislative process from each of the health
center medical directors, the Hawaii Primary Care Association, and a
number of other interested parties. Access to high quality health
care has been psychologys fundamental stance. Accordingly, it is
quite interesting to note that upon the convening of the RxP Task
Force by the legislator co-chairs, the University of Hawaii
Department of Psychiatry offered the health centers: one psychiatric
resident (with attending) available to give each neighbor island
health center ½ day/month of psychiatric consultation and follow-up.
After the first visit to the health center, follow-up will be
available by VTC. In ½ day/month the psychiatric resident can
follow-up with 2-3 patients and/or do consults and in-service
education with clinicians. This approach by psychiatry geared to
undercut psychologys access argument is very familiar to Elaine
LeVine and Mario Marquez after their experiences in New Mexico.
Hopefully this time, however, the medical community will actually
follow through on its offer and at least some of Hawaiis underserved
citizens will receive the care that they require. Aloha,
Pat DeLeon, former APA President Division
42 November, 2005
The Prescriptive Authority Agenda In our last column we
reported that: During the last legislative session, the Hawaii
Psychological Association, in collaboration with the Hawaii Primary
Care Association, nearly obtained prescriptive authority (RxP) for
their members working within federally qualified community health
centers. The resulting legislatively mandated RxP Task Force was a
major accomplishment. Louisiana Psychological Association President
Jim Quillin stressed that: the medical in medical psychology is an
adjective that modifies rather than defines who and what we are
psychologists. Ray Folen is a member of the Hawaii RxP Task Force.
His report on their first meeting this October:
The first meeting of the legislatively mandated RxP Task
Force started with a parking lot encounter with the anti-RxP
psychiatrist assigned by organized psychiatry to represent them
during the discussions. He greeted me with an obvious dig So what
do you guys do? Testing, right? I didnt offer him the courtesy of
a reply as we walked to the State Capital for our meeting with the
legislators chairing the task force. One thing was clear, though: he
was feeling threatened. My colleagues and I knew he confided in
others that it was only a matter of time before psychologists had
prescriptive authority. His job was to stave off the inevitable as
long as possible. I might have felt some sympathy for his situation,
were it not for the fact that he had little to offer in the face of
the desperate need for mental health services in our state. We, like
most areas of the country, have a critical shortage of psychiatrists,
particularly in rural and underserved areas and we have a desperate
need for pediatric psychiatrists in particular. Inpatient adolescent
units have had to close due to a lack of psychiatrists.
Is there any chance they will be able to improve this
situation in the future? The answer is a resounding No.
Psychiatry residencies have to pull 40% of their residents from
foreign countries due to a lack of U.S. applicants. Only three
percent of psychiatry graduates have plans to work in rural or
underserved areas. Hawaii psychologists, on the other hand, can be
found in almost all areas of the state. A large percentage are
providing psychological services to children. Psychologists are
found in most of the federally-designated community health centers
(CHCs), whose charter is to provide services in underserved areas.
The CHC psychologists work collaboratively with the primary care
physicians to provide their patients with appropriate therapy and
adjunctive pharmacological interventions when needed.
Prescriptive authority is only meaningful in appropriate
context, and the primary care psychology model is one that makes the
most sense to us. Primary care psychologists work in a primary care
clinic. They provide traditional behavioral health services (e.g.,
treatment of depression, anxiety, substance abuse), as well as more
specialized behavioral medicine services (e.g., treatment of obesity,
high blood pressure, diabetes, headache). In our experience, family
practitioners welcome psychologists in their clinics. These
psychologists not only provide an opportunity for the immediate
referral of the distressed patient, but also provide truly
comprehensive treatment in the primary care environment. The
patients welcome the seamless continuity of their overall health care
and appreciate the lack of stigma that has been historically
associated with behavioral health care. Additionally, insurance
companies are beginning to realize that services provided in this
manner are leading to a reduction in overall healthcare costs.
Many primary care psychologists (almost all of those in
Hawaii) have received additional training in psychopharmacology.
This is particularly valuable as psychologists are often the sole
behavioral health provider in our rural clinics. Over the last
several years, the primary care providers, with an average of six
weeks of mental health training and limited formalized
psychopharmacologic education, have come to rely on our expertise and
that of nurse practitioners in this area. It is noteworthy that the
CHC medical directors wrote a letter to the state legislature
endorsing prescriptive authority for psychologists last legislative
session.
This scenario could be repeated in other places.
Federally-qualified CHCs can be found in every state. Primary care
psychologists have clearly demonstrated their proficiency in this
venue and it is imperative that we continue to do so. As more
psychopharmacology-trained psychologists provide services in the
primary care environment, it will offer an increasingly convincing
argument for the value this expertise provides to our patients and
our communities alike. Unlike some of our psychiatric colleagues, we
have begun to respond to the behavioral health care crisis by
walking the walk, not simply talking the talk.
Our sincerest congratulations to Jill Oliveira-Berry and
Robin Miyamoto for their success in obtaining and maintaining active
support throughout the legislative process from each of the health
center medical directors, the Hawaii Primary Care Association, and a
number of other interested parties. Access to high quality health
care has been psychologys fundamental stance. Accordingly, it is
quite interesting to note that upon the convening of the RxP Task
Force by the legislator co-chairs, the University of Hawaii
Department of Psychiatry offered the health centers: one psychiatric
resident (with attending) available to give each neighbor island
health center ½ day/month of psychiatric consultation and follow-up.
After the first visit to the health center, follow-up will be
available by VTC. In ½ day/month the psychiatric resident can
follow-up with 2-3 patients and/or do consults and in-service
education with clinicians. This approach by psychiatry geared to
undercut psychologys access argument is very familiar to Elaine
LeVine and Mario Marquez after their experiences in New Mexico.
Hopefully this time, however, the medical community will actually
follow through on its offer and at least some of Hawaiis underserved
citizens will receive the care that they require. Aloha,
Pat DeLeon, former APA President Division
42 November, 2005
