Another RxP Update:

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by edieb, Nov 21, 2005.

  1. edieb

    edieb Senior Member
    10+ Year Member

    Aug 27, 2004
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    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 didn’t 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
    “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 psychology’s 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 psychology’s 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 Hawaii’s underserved
    citizens will receive the care that they require. Aloha,
    Pat DeLeon, former APA President – Division
    42 – November, 2005

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