Washington, D.C. – The American Psychological Association’s 2008 State Leadership Conference focused on gaining greater clout for change through lobbying or litigating to protect and expand the purview of psychology.
The big picture in plenary sessions for the roughly 600 in attendance stressed playing a defining role in enacting a national parity law and negotiating with managed care organizations or joining court actions to force them to improve payment rates.
Workshops and breakout groups emphasized the need for strong efforts at the state level, such as lobbying more states to allow psychologists with proper training to prescribe psychotherapeutic drugs and to enhance the image of doctoral psychologists through a revised model licensure act.
Norman Anderson, Ph.D., APA’s chief executive officer, drew applause when he pointed out that the U.S. House passed the Paul Wellstone Mental Health Parity Act on March 5, just days before the March 9-12 conference opened.
But it was quickly added that the House version, named for Minnesota Sen. Paul Wellstone who died in a 2002 plane crash, differs considerably from the version passed by the U.S. Senate last September.
The House bill requires health plans to include coverage for substance abuse and all disorders included in the DSM-IV and would preempt state standards that fall short of that. The Senate bill requires only that insurers meet existing state or federal standards of mental health care. A House-Senate conference committee must resolve differences if the bill is to pass this year. The White House supports the scaled-back Senate version.
Both versions call for eliminating many inequities permitted under the Parity Act of 1996, such as requiring higher employee co-pays for mental health treatment or setting lower limits on visits for mental health care than those allowed for medical or surgical procedures.
In the continuing battle with managed care, Randy Phelps, Ph.D., interim executive director of the Practice Directorate, similarly drew applause when he assured that the directorate will continue through all means available to champion “a fair wage for those of you who are taking care of the public.”
Katherine Nordal, Ph.D., then executive director-designate who now heads the directorate, vowed to continue that battle. “I know that practitioners are hurting,” Nordal said.
Phelps said bread-and-butter issues, such as payment rates, are the reason psychologists must increase their political presence at both the state and federal level. “If you are not part of the decision-making you will always be downstream second-class citizens.”
In an RxP workshop, Mario Marquez, Ph.D., president of the American Society for the Advancement of Pharmacotherapy, Division 55, spelled out the long-term goal unequivocally: gaining prescription privileges in all U.S. states and territories. Currently, only two states, Louisiana and Marquez’ home state of New Mexico, and the territory of Guam grant RxP privileges to psychologists.
Marquez predicted Missouri will approve RxP for psychologists this year and added, “We’re looking at a couple of other states in 2009.” He said Division 55 would send “SWAT teams” to assist states in their efforts, similar to the January rally in Kansas City that helped Missouri supporters get a majority of Missouri House members to sign on as cosponsors of an RxP bill before it was officially introduced as legislation.
Morgan T. Sammons, Ph.D., dean of the California School of Professional Psychology at Alliant University, who is a prescribing psychologist and a graduate of the Department of Defense Psychophar-macology Demonstration Project, said the medical community’s chief objection to granting prescribing privileges to psychologists – that it will jeopardize patient safety – is fallacious.
Sammons said the same argument was raised when limited prescription authority was granted in other fields, such as optometry and podiatry, but no problems have ever surfaced. “Nobody has ever demonstrated the validity of the patient-safety argument,” Sammons said.
Melba J.T. Vasquez, Ph.D., chair of the task force revising the model licensure act, said the task force “will probably have one more meeting in the fall” and expects to present the final draft to the APA Council in February.
The most controversial element in the proposal is elimination of the exemption that allows non-doctoral school psychologists to use the terms “psychologist” and “psychology.”
The exemption was included in the first model act approved in 1955 and was retained in revisions passed in 1967 and 1989, although it was presented as a temporary measure to allow time for master’s level school psychologists to upgrade to doctoral status.
The proposed elimination drew fire from the National Association of School Psychologists (NASP) and prompted about 9,000 letters and e-mails in opposition during the task force’s period for receiving public comments. Vasquez said about 8,700 of the objections were on a form composed for members by NASP officers.
Tammy L. Hughes, Ph.D., president of the Division of School Psychology, Division 16, said the division opposes the change. “We’ve asked to retain the exemption,” she said.
Hughes said although NASP does not require doctoral degrees the organization has fostered increased standards for school psychologists over the years and most states now require a “specialist” certification, which involves about two years of training after receiving a master’s degree.
Division 16 allows specialist-level school psychologists to join as “professional affiliates” but NASP has remained the strongest lobbying force for school psychologists.
Hughes said some practicing psychologists feel master’s level school psychologists are infringing on their turf because some states, including her home state of Pennsylvania, permit school psychologists to engage in private practice, usually with students or their family members.
“That’s a slippery slope,” she said.
Ronald Palomares, Ph.D., assistant executive director of the Practice Directorate for policy advocacy in the schools, said eliminating the exemption would at most require “a name change” for master’s level school psychologists, such as “licensed specialist in school psychology” (LSSP), the designation used in Vasquez’s home state of Texas.
Palomares said there are valid pro and con positions on the proposed elimination but even if it is adopted by the APA Council it is up to individual state legislatures to decide whether to follow suit. He said most states that adopt the change likely would grandfather in current school psychologists to let them retain their titles.
“It (changing state laws) doesn’t happen overnight,” Palomares said, pointing out that the 1987 revision of the model act added requirements for continuing education but five states, including New York, still do not require CE credits.
Vasquez said other proposed revisions call for adopting language on RxP privileges, adjusting the recommended education sequence to allow supervised training either before or after receiving a doctoral degree, facilitating mobility among jurisdictions, allowing I/O psychologists to seek licensure to distinguish themselves from non-doctoral workers in the field and including a few “tweaks” in scope of practice language.
In an aside to the conference, a delegation from New York took the opportunity to hold a closed-door session with top APA officers on concerns that trouble their members.
The agenda for the meeting was hashed out in a one-year study by the New York State Psychological Association’s “Task Force on the Crisis in Private Practice” co-chaired by Frank Goldberg, Ph.D., and Barbara Fontana, Ph.D.
Goldberg said primary concerns center on developing a model approach for a statewide independent practice association to better integrate psychologists with medical care, mounting an effective assault on insurance monopolies that violate antitrust laws to exploit practicing psychologists, pressing for reforms to improve access to health care by eliminating administrative inefficiencies and allying with other organizations with a common interest in health care reform.
Goldberg said the state delegation included NYSPA President Richard Wexler, Ph.D., Past President Dianne Polowczyk, Ph.D., and APA Council Representative Sharon Brennan, Ph.D.
APA officers who met with them included Phelps, Nordal, President Alan Kazdin, President-elect James Bray, Ph.D., Daniel J. Abrahamson, Ph.D., assistant executive director of the Practice Directorate for state advocacy, and Sanford Portnoy, Ph.D., chair of the Committee for the Advancement of Professional Practice (CAPP).