Legislative Update: March 2009
Graduate Psychology Education (GPE) Program
GPE Grants: Since 2002 the GPE Program, which is administered through the Bureau of Health Professions, has awarded 70 grants to 30 states totaling almost $24 million.
GPE Appropriations: Unfortunately for FY 2009, the GPE Program was flat-funded once again at $2 million even though the House asked for $4 million. During the current cycle, there are more House Labor-Health & Human Services-Education Appropriations Subcommittee members than in the past who will ask for $7 million for the GPE Program for FY 2010. They include Representatives Rosa DeLauro (D-CT), Jesse Jackson Jr. (D-IL), Lucille Roybal-Allard (D-CA), Nita Lowey (D-NY), Patrick Kennedy (D-RI), Tim Ryan (D-OH). A couple of other House subcommittee members are also seriously considering making the GPE Program a priority. The Senate is more challenging. We expect support from most of the Democrats on the Labor-Health & Human Services-Education Appropriations Subcommittee but it is unclear whether we will find a champion. Senator Patty Murray is again trying through both the VA authorizing committee and appropriations subcommittee to get $5 million transferred to the GPE Program for a focus on veterans.
GPE Authorization: Senator Daniel Inouye (D-HI), Chair of the Senate Appropriations Committee will soon be introducing a bill, The Graduate Psychology Education Act of 2009, to formally authorize the GPE Program. Its statutory authority is based on a provision in the Public Health Service Act that allowed for funding training in mental health professions. The Chairman of the House Energy & Commerce Health Subcommittee, Frank Pallone (D-NJ) has agreed to accept that bill and we are working with APA members to find a member of that subcommittee to be an original sponsor in the House.
There is a provision to authorize the GPE Program as well as add psychology to the Bureau of Health Professions geriatric training programs in another bill – The Health Professions and Primary Care Reinvestment Act (Representative Diana DeGette, D-CO). This bill would amend Title VII of the Public Health Service Act to: (1) address workforce shortages for primary care health professions; (2) assist underrepresented minorities or disadvantaged students to enter health professions; (3) authorize the GPE Program; (4) expand geriatrics training initiatives to include graduate programs and professionals in behavioral and mental health; and (5) improve national health workforce analysis efforts.
Psychology & Other Health Workforce Bills
The Health Access and Health Professions Supply Act (Senator Jeff Bingaman, D-NM) would amend the Social Security Act and make cost of training psychology interns eligible for Medicare payments to hospitals. In addition this bill also amends the Public Health Service Act and makes psychology eligible through the term “behavioral and mental health professionals” for membership on a permanent national health workforce commission (we are working on getting psychology specifically named in this provision). In addition psychology would be included by being named or through the term “behavioral and mental health professionals” in: (1) any workforce data collection and analysis; the expansion of the National Health Service Corps Scholarship and Loan Repayment Program; (2) training to become commissioned officers in the Public Health Service through a newly established Public Health Science Track; and (3) a new Health Professions Training Pipeline Partnerships Program to increase the number of young adults entering the health professions.
The Retooling the Health Care Workforce for an Aging America Act (Senator Hebert Kohl, D-WI) also amends Title VII of the Public Health Service Act to: (1) expand funding for Geriatric Education Centers for grants to offer short-term intensive courses in geriatrics; (2) expand the Geriatric Academic Career Awards program to include junior faculty in nursing, social work, psychology, and allied health disciplines; (3) authorize a new Geriatric Career Incentive Awards program to provide financial support for psychology students and masters level clinical social workers who wish to pursue a doctorate or other advanced degree in geriatrics, long-term care, geropsychology, or chronic care management; and (4) analyze current and projected needs for health care professionals and paraprofessionals in the long-term care sector. This legislation would also authorize a researchstudy on the geriatric mental health workforce.
The Child Health Care Crisis Relief Act (Representative Patrick Kennedy, D-RI) would also amend Title VII of the Public Health Service Act to support the professional training of individuals to provide mental health services for children and adolescents, including: (1) entering into contracts with qualified individuals to pay educational loans in exchange for providing mental health services to children and adolescents; (2) awarding scholarships to students who agree to work as child and adolescent mental health service professionals after graduation or completion of residency or fellowship; (3) awarding competitive grants to higher education institutions to establish or expand internship or other field placement programs for students receiving specialized training or clinical experience in child and adolescent mental health; and (4) awarding grants to higher education institutions to establish or expand graduate child and adolescent mental health training programs. This legislation would also authorize a study on the distribution of, and need for, child mental health professionals and on a comparison of such distribution and need on a state-by-state basis.
APA Health Care Reform Integrated Health Care Priority
The Education Government Relations Office (GRO) has been advocating for integrated health care that includes mental and behavioral health, and in particular psychological services, since 1994 as part of its efforts on gaining access for psychologists and psychology trainees in the National Health Service Corps and Community Health Center Program. APA Practice Organization, Public Interest GRO and Education GRO will be promoting integrated heath care with Congress. Education GRO had an opportunity to send along APA’s workforce recommendations to the White House through a Member of Congress and included APA’s integrated health care recommendations.
APA Health Care Reform Workforce Priorities
The Graduate Psychology Education Act would authorize the Graduate Psychology Education (GPE) Program, which was established in 2002 to provide funding to accredited psychology doctoral, postdoctoral, and internship programs for interdisciplinary training for underserved populations (e.g., older adults; children; chronically ill persons; and victims of abuse and trauma, including military service members and veterans) in rural and urban communities.
The Minority Fellowship Program of the Substance Abuse and Mental Health Services Administration helps to reduce racial and ethnic disparities in mental health status and to improve the quality of mental health services for minority populations. This highly successful program provides training primarily to minority mental health professionals to offer culturally and linguistically appropriate, accessible mental health and substance use services for diverse populations.
The National Health Service Corps and Federally Qualified Health Centers provide integrated health care services for individuals across the lifespan in underserved communities. Independently, and through the National Health Service Corps, psychologists serve as essential members of interdisciplinary health care teams providing mental and behavioral health services.
The Caring for an Aging America Act would amend Titles VII and VIII of the Public Health Service Act to: (1) establish the Geriatric and Gerontology Loan Repayment Program for physicians, physician assistants, advance practice nurses, psychologists, and social workers; (2) expand eligibility for the Nursing Education Loan Repayment Program; (3) strengthen the existing Career Ladder Grants Program to expand career advancement opportunities for direct care workers in long-term care settings; and (4) establish a Health and Long-Term Care Workforce Advisory Panel.
The Health Professions and Primary Care Reinvestment Act (see above under “GPE Authorization”)
The Retooling the Health Care Workforce for an Aging America Act (see above under “Psychology Other Health Workforce Bills”)
National Health Service Corps (NHSC) and Federally Qualified Health Centers (FQHC) Primary Care Initiative
NHSC & Community Health Center Program FY 2009 Funding: The National Health Service Corps will receive $14 million more for a total of $135 million with an emphasis on field placement and psychologists are among those health professionals eligible for this funding. In addition, the NHSC is encouraged to support multi-year rather than single year commitments. The Community Health Center (CHC) Program received an increase of $125 million and will be funded this year at $2.2 billion making it possible for hiring more psychologists and other health professionals. In the Stimulus package there is an additional $300 million for the NHSC for recruitment and field operations and an additional of $500 million for CHCs for a limited time of up to two years.
NHSC Financial Aid Programs: Psychologists are eligible through the Loan Repayment Program (LRP). There are currently 370 psychologists in the NHSC LRP and since our advocacy effort to gain access for psychologists beginning in 1995, there have been 777 psychologists in the NHSC.
There is a committee of APA members who are NHSC LRP participants and/or Ambassadors and others who are interested in the NHSC that is communicating on concerns that need to be addressed, including barriers to matching psychologists with designated sites or Health Profession Shortage Areas (HPSA) due to licensing and funding issues, the ineligibility of school psychologists and the lack of access of psychologists to the NHSC Scholarship Program. We are preparing Report Language for the FY2010 appropriations bill on some of these issues and will take those issues and the others to the new Health Resources and Services Administration (HRSA) Administrator and NHSC Director.
FQHC Primary Care Initiative: The FQHC’s, which are funded through Section 330 of the Public Health Service Act, include community health centers, migrant health centers, health centers for the homeless and public housing based health centers that were given an additional $500 million for new sites and services.
Since 1994 Education GRO has approached Congress, both authorizing and appropriations committees and HRSA, on gaining access for psychologists to the NHSC and through that program being matched to and hired by Community Health Centers. The Practice Directorate assisted in the beginning with outreach to other relevant associations and recently with a joint effort that focuses on reaching out to state Primary Care Associations (PCAs) that are the umbrella organization for the state’s FQHCs.
On September 19, 2008 during the Fall Consolidated Meetings in Washington, DC, the Education GRO and the Practice Directorate Committee on Rural Health (CHC) hosted an all-day meeting on the role of psychologists and trainees in FQHCs. Attending were key APA members with interest and expertise in rural health, integrated health care, and those in underserved communities represented by the Public Interest Directorate Socioeconomic Status Committee. They included Gil Newman, PhD, Wright Institute of Berkeley, CA. Parinda Kahtri, PhD of the Cherokee Health Systems of Talbot, TN and Ben Miller, PsyD University of Massachusetts. Dr. Miller & Kathri spoke about successful efforts at integrated health care including psychologists, and Dr. Newman addressed efforts in CA to place psychologists and psychology trainees in Community Health Centers that began in collaboration with Education GRO staff. Other invited guests included Gina Capra, a representative for the US Bureau of Primary Health Care (BPHC) in the Health Resources and Services Administration, and Michael Lardiere of the National Association of Community Health Centers (NACHC). Both spoke about the FQHC program and the efforts to address the mental and behavioral health needs of the underserved.
As a result of that meeting, efforts by Education GRO to work with state PCAs for the inclusion of psychologists and psychology trainees in Community Health Centers began in NM, ME and are planned for NH, MT and possibly AK.
Substance Abuse/Mental Health Services Administration (SAMHSA)
Campus Mental and Behavioral Health Services: Education GRO staff are seeking the inclusion of the Mental Health on Campus Improvement Act as part of the SAMHSA reauthorization in the 111th Congress. The Mental Health on Campus Improvement Act will soon be introduced in the Senate by Senators Durbin and Collins and by Rep. Jan Schakowsky in the U.S. House of Representatives.
The Mental Health on Campus Improvement Act: This legislation would provide critically needed mental and behavioral health services to students on campus. Through a competitive grant process, administered by SAMHSA, the Mental Health on Campus Improvement Act would enable institutions of higher education to use funds for providing mental and behavioral health services to students (prevention, screening, early intervention, assessment, treatment, management and educational services), employ appropriately trained staff; and expand training opportunities through internship, post-doctorate, and residency programs. In addition to supporting mental and behavioral health services for students, the bill outlines a National Public Education Campaign designed to focus on mental and behavioral health on college campuses, as well as establishes an Interagency Working on College Mental Health.
In tandem with that effort, Education GRO will seek the continuation of the Campus Suicide Prevention Program and advocate for an increase in its Authorization of Appropriations (increase the funding ceiling to $10 million). Authorized first as part of the Garrett Lee Smith Memorial Act and housed at SAMHSA, the Campus Suicide Prevention program is a small but effective competitive grant program that makes funds available to institutions of higher education to enhance education and outreach services to students with mental and behavioral health problems, such as depression, substance abuse, and suicide attempts. Senator Jack Reed is the champion of this program.
Education GRO staff will work in the upcoming months to secure additional House and Senate co-sponsors of this legislation. Again, Education GRO’s goal is to have these programs included as part of SAMHSA during the reauthorization of that Agency, which is slated for review and renewal during the 111th Congress.
Applications for SAMHSA Campus Suicide Prevention grants were due on November 25, 2008. It is anticipated that SAMHSA will make approximately 21 grants of up to $100,000 per year for three years. Institutions of Higher Education are eligible to apply and institutions may carry out the activities of this grant through college counseling centers, college and university psychological services centers, mental health centers, psychological training clinics, or institutions of higher education-supported, evidence-based mental health and substance abuse programs. These grants will be announced this summer.
Elementary and Secondary Education Act Reauthorization
Education GRO, in partnership with the Public Interest, Science and Practice Directorates, developed recommendations to improve the “No Child Left Behind Act”, which is set for reauthorization during the 111th Congress. The “No Child Left Behind Act” expired in 2007 and APA has promoted a set of changes to that legislation since the first attempt to reauthorize the law during the 110th Congress. The recommendations cover such issues/areas as growth model, English language learners, teacher professional development, elementary and secondary school counseling and parental involvement. Education GRO, working with Education Directorate and GRO colleagues will reconsider these recommendations and include others that are relevant to the education debate in light of changing times and changing needs.
Education GRO also submitted a comprehensive list of APA members to the House Education and Labor Committee, as well as the Subcommittee on Early Childhood, Elementary and Secondary Education, in anticipation of upcoming hearings on the reauthorization of “No Child Left Behind.” We will continue to work with the House Committee, as well as the Senate Health, Education, Labor and Pensions Committee, to promote relevant psychological research and psychologists with research backgrounds and expertise in teaching and learning during the hearing process.
The Higher Education Act Implementation
In late February, the U.S. Department of Education announced negotiated rulemaking meetings related to the implementation of the Higher Education Opportunity Act of 2008 (PL 110-315). This process will allow for five committees to prepare proposed regulations for the newly enacted law. The Committees are: Team I, General/Lender Loan Issues; Team II, School-based Loan Issues; Team III, Accreditation; Team IV, Discretionary Grants (to include TRIO, GEAR UP, HEP and CAMP); and Team V, General and Non-Loan Programmatic Issues.
In early March, the first meeting of the Accreditation group was held. Discussion centered on assessing distance education, monitoring of institutions that are growing and appeals by institutions to accrediting agencies. The next Accreditation session will be held in late April.
Education GRO will continue to monitor this process in partnership with the Office on Accreditation.
Education Advocacy Coalition Activities
Health Professions Coalitions: Education GRO continues to participate in the Health Professions & Nursing Education Coalition (HPNEC) and Friends of HRSA (Health Resources & Services Administration) and, in partnership with the Public Interest (PI) Directorate and PI GRO, have joined and taken the lead on legislative issues for the newly established Eldercare Workforce Alliance (EWA).
Education Coalitions: APA is a founding partner of the Higher Education Mental Health Alliance (HEMHA). Education GRO staff will serve as the point of contact for this new coalition, which seeks to provide leadership through a partnership of organizations to advance college mental health.
Education Advocacy Grassroots Activities
Development of Advocacy Training Session for CE Credit: In addition to the current on-line advocacy training webinars, which were launched last year by the Education Government Relations Office (GRO), as well as the joint Education and Public Interest GRO advocacy curriculum project, the Education GRO staff is also in the process of recording advocacy training sessions. These sessions are to be offered through the APA Continuing Education (CE) Office and are based on the webinars and curriculum project. The first CE Advocacy training session – Advocating for a Piece of the Federal Pie: Gaining support for Psychology Education and Training – provides an overview of the federal legislative process, as well as the key elements of a successful advocacy strategy, and is aimed at novice advocates. It is expected that the first advocacy CE on-line session will be available in spring 2009.
APPIC Education Advocacy Training Workshop:As part of the ongoing efforts to raise awareness of the critical role that advocacy plays in gaining federal support for psychology education and training, Associate Executive Director for Education GRO, Nina Levitt, will conduct an advocacy training workshop during the 2009 APPIC conference to be held in April in Portland, Oregon. The workshop is aimed at individuals new to advocacy, as well as members wishing to refresh their advocacy skills.