Feature Article

Let the good times roll

The author discusses Federally Qualified Community Health Centers, educational games among other topics

By Patrick H. DeLeon, PhD
Federally Qualified Community Health Centers (FQHCs)

One perhaps unique perspective, which is developed by working on Capitol Hill, is an appreciation for the extent to which various governmental agencies possess fundamentally different missions. For the vast majority of our colleagues working within the public sector, their underlying mission is to provide needed quality services for designated beneficiaries. Within the Department of Health and Human Services (DHHS), the Health Resources and Services Administration (HRSA) is one of the leading federal agencies addressing the pressing needs of our nation's historically underserved populations. Mary Wakefield, PhD, the administrator of HRSA, attended an earlier APA convention. She recently presented her FY (Fiscal Year) 2015 budget request: “HRSA is the primary Federal agency for improving access to health care services for people who are underinsured, isolated or medically vulnerable…The implementation of the Affordable Care Act (ACA) presents opportunities to improve access and care quality. A major component of our budget strategy is to ensure that HRSA's portfolio of programs, including the health center and health workforce programs, are fully aligned with the ACA. The ACA makes it possible for these programs to be more effective and have an even broader impact on the health of individuals across the country.

In FY 2015, the Health Center program will continue to provide high quality, affordable and comprehensive primary care services in medically underserved communities even as insurance coverage expands. This makes health centers a critical element of the nation's health care system. The Budget requests the resources needed to meet a surge in newly-insured patients seeking care at health centers across the country. The Budget includes $4.6 billion for the Health Center program, including $3.6 billion in mandatory funding through the ACA. HRSA's FY 2015 budget invests resources to increase the number of health care practitioners in areas of the country experiencing shortages…(It) also provides two new workforce initiatives, including $10 million to support a new Clinical Training in Interprofessional Practice program to increase the capacity of community-based primary health care teams to deliver quality care… (And) includes $125 million to improve both access to and the quality of health care in rural areas. It will strengthen regional and local partnerships among rural health care providers, expand community-based programs and promote the modernization of the health care infrastructure in rural areas. These efforts will enhance the ability of those insured through the ACA to obtain health care in rural communities… Our FY 2015 budget request places a strong emphasis on investing in programs that improve access to health care in underserved areas and allows the Health Resources and Services Administration to take important steps toward advancing the impact of the ACA and improving health care access, particularly for underserved populations.

Federally qualified community health centers are the nation's true safety net, having been established as an integral component of President Johnson's Great Society initiative, when psychologist John Gardner was Secretary of the then-Department of Health, Education, and Welfare (HEW). Visionary Bob McGrath, director of integrated care for the underserved of northeastern New Jersey and the psychopharmacology training program at Fairleigh Dickinson University: “We just received a HRSA Graduate Psychology Education (GPE) grant to embed psychology doctoral students in a local FQHC.” Bob's success reflects Wakefield's vision that: “Strengthening the mental and behavioral health workforce is a critically important component of our overall efforts to expand the nation's health care workforce. Far too many Americans live in areas of the country – both rural and urban – with limited access to mental and behavioral health services.” In our judgment, federally qualified community health centers, even more than community mental health centers, are the future of public service psychology. As our colleagues are seeing across the nation during intense local political debates, the U.S. Supreme Court left the final decision as to whether or not to fully expand Medicaid coverage, as envisioned by the ACA, to the individual states. As a result, researchers at George Washington University report that more than one million Americans utilizing FQHCs will remain uninsured (and still receive care) simply because they live in one of the 24 states that, to date, has chosen not to expand Medicaid.

A Vision from the Front Line

The Institute of Medicine (IOM) recently issued a call for nominations of candidates for a new anniversary fellowship in osteopathic medicine supporting an early career scholar. Created to celebrate the 35 th anniversary of the IOM's establishment, the purpose of the IOM anniversary fellows programs is to enable talented, early career health policy or health science scholars to participate actively in the work of the IOM and to further their careers as future leaders in the field. This newest addition to the anniversary fellowship program joins others in the fields of obstetrics and gynecology, internal medicine, family medicine, pharmacy, biomedical science, population health and health policy. The fellowships are awarded for a two-year period, during which time the fellows are expected to continue working at their main academic post. They will be assigned to a board of the IOM, attend its meetings, and actively participate in the work of an appropriate expert study committee or roundtable, including contributing to its report or other products. The fellows are invited to the IOM annual meeting and also to take part in an intensive one-week orientation to health policy in Washington, D.C. This introduces the fellows to a variety of perspectives, including that of legislators, government officials, industry, patient interest groups, scientists and health professionals. Each fellow is assigned to an IOM member who will serve as a senior mentor for the duration of the fellowship. In addition, each fellow is provided with a flexible research stipend of $25,000. Fellowships require a commitment of 10-20 percent time.

Hopefully APA will eventually invest in a similar IOM fellowship for psychology's future academic leaders.

As I sit at my desk in the California Capitol, I am taking a moment to breathe and reflect on the past two weeks. I have been working on a number of controversial bills before the Senate. One of them is a bill that would require all mental health professionals to show evidence of suicide prevention training as a prerequisite for licensure. For those who are already practicing, they will have to take a onetime CE course on suicide prevention. As I examine the rationale provided for this bill, I am shocked. It appears that everyone has been so focused on the recent suicides that the media has highlighted that they have neglected to do a thorough review of the literature in this area. In moments like these, I realize that the empirical evidence to light via my analysis of this bill. Ultimately, it is up to the legislators to vote; but the analyses I write serve as a background and context for the decisions they make.

-  Le Ondra Clark Harvey, consultant to the California Senate Committee on Business, Professions and Economic Development.

Earlier in the year, Le Ondra had noted: “How difficult it was for me to forge a path into the policy arena with no psychology mentors who were doing work in policy and no models for how to get into the policy arena.”

The Times They Are A-Changin'

The American Association of Colleges of Pharmacy (AACP) is engaged in a new venture, Professions Quest (PQ), in order to develop and produce serious educational games for the health care professions. Launched this year, it is located at the Simulation and Game Institute in Manassas, VA. PQ will release its first game Mimyex – in Jan. 2015. The competency framework for each quest in the game will be derived from the Core Competencies for Interprofessional Education released in May 2011 by the Interprofessional Education Collaborative (IPEC), which APA has endorsed. Today's students expect 24/7 access to information and opportunities for learning. At the same time, higher education leaders are redefining the institution as it has historically functioned. To meet the needs of the learner now and into the future, leaders must examine the current models for education and develop engaging alternatives. New models must be student-centered and change the learning experience. PQ will develop and publish virtual, interprofessional, and interactive multiplayer learning solutions targeted specifically towards health professions education institutions and health professions students. These products and services represent a unique vehicle for interprofessional education – and will deliver increased interaction, collaboration, and knowledge among the health professions and health professions students. Each player, or player team, will be able to access the Mimyex game and all of their personal and game performance data on desktops or mobile devices anywhere in the U.S. Students can benchmark their performance in the game against other health professions students. The education and health care environments are fundamentally changing, with the unprecedented advances occurring almost daily within the communications and technology fields.

The IOM Board on Children, Youth, and Families (BCYF), under the leadership of Kimber Bogard, has a similar appreciation for the impact of technology on the evolving environment of the health care and education fields.

As part of our continued communications efforts for the BCYF report ‘Sports-Related Concussions in Youth: Improving the Science, Changing the Culture,' we have launched a nationwide video contest to help raise awareness among young athletes about the importance of taking concussions seriously. The ‘Play It Safe' video contest is open to anyone ages 13 to 22 interested in creating a 30- to 60-second public service announcement about sport-related concussions. Topics for the videos may include how youth can overcome a sports culture that often promotes shaking it off and getting back in the game, and how they can help teammates, coaches and parents better recognize the signs, symptoms, and need for proper treatment of concussions. The IOM/NRC will pick three winners – one from each age group of middle school, high school, and post-high school – who will each receive a $300 gift card.

Sports teach valuable lessons – about teamwork, goals, leadership, how to handle defeat and learn from mistakes. One lesson we're still learning, though, is when not to play. Some players resist reporting their injuries or may not take all the time they need to heal, and they can feel pressured to act this way because of their fellow teammates, coaches, or parents. As many as 1.6 million to 3.8 million sports- and recreation-related concussions and other traumatic injuries are reported each year in the United States.

Inspiring Developments Within APA

Div. 18 President Anne Klee recently announced:

The APPIC-Training Communities CoA Nomination Committee is soliciting nominations for candidates for the APA Commission on Accreditation. Community Mental Health Centers and Prisons are specifically identified as communities of interest. This year the Committee will consider individuals representing the internship level of training.” The Division's voice will be heard. As Katherine Nordal passionately proclaimed at this year's extraordinarily exciting State Leadership Conference (SLC): “Health care reform implementation is a work in progress. As we confront serious problems and the uncertainty of a health care system in flux, psychology continues to demonstrate that we're poised to face those challenges. We achieve good results when psychologists get energized and commit themselves to making positive things happen.”

A Fantastic Accomplishment

On June 25, 2014, Beth Rom-Rymer:

Illinois has now become the third state in the country in which licensed clinical psychologists with advanced, specialized training can prescribe medications for mental health disorders. Governor Pat Quinn (D), a populist governor who has taken political risks to support social services and mental health care for the underserved in our state, signed our prescriptive authority bill, sponsored by the Illinois Psychological Association, today, at 3:41 CDT. Our bill had been powerfully and effectively championed by Senator Don Harmon (D), Senator Dave Syverson (R), Representative John Bradley (D) and Representative Raymond Poe (R).

The rhetoric used against us had been fierce and unrelenting. Our heroic legislative sponsors brought the American Nurses Association - Illinois Chapter and the Illinois Society for Advanced Practice Nursing to our side. What brought the state medical and psychiatric societies to the negotiating table were the psychologists' successive legislative victories in both the Senate and the House; the steady growth of psychology's support from state labor unions, statewide law enforcement associations, African American and Latino/a religious and advocacy networks, and other influential groups; and our steadfastness in staying the course. In the end, the medical society and the psychiatric society changed their positions from ‘opposed' to ‘neutral.' No significant opposition remained and the votes in both the Illinois State House and State Senate, on May 29 and 30, were overwhelmingly favorable, with the state Senate passing our bill unanimously: 57-0.

While there are constraints in our law, currently, I have no doubt that these constraints will be lifted over time as our prescribing psychologists demonstrate, not only safe prescribing, but effective prescribing. After all, prescribing psychologists have a full array of robust therapeutic (psychological as well as pharmacological) interventions that they can make.

There has been some criticism of our negotiating with our fiercest adversaries and coming to a ‘negotiated settlement.' The beauty of our collaborative work, however, is that the resistance of psychiatrists to working with prescribing psychologists, in the hospitals, medical centers, and training institutions throughout our state is dissipating. All of the medical health providers have officially agreed that psychologists, with specialized training, can prescribe. Furthermore, in addressing the infrastructure of mental health in our state, the mental health consumer advocacy organizations, such as NAMI, which have been historical adversaries, are beginning to see us as effective and potent partners in addressing the critical mental health shortages in our state. It has taken a long time for us to get here, but we have many more miles to travel still before we sleep.”

Well, it makes no difference whether you're young or old. Aloha.