Public Policy Office, APA
(This article was first published in the Winter 2002 issue
of the APAGS Newsletter.)
In the wake of the September 11th
terrorist attacks, APA’s Public Policy Office (PPO) has been actively engaged
with both the Congress and key federal agencies to respond to critical national
needs. This report gives you a flavor for the varied initiatives undertaken by
our Education, Public Interest, and Science Policy staff in such areas as
creating in-service training programs for mental health professionals to respond
to disaster and terrorism, providing health insurance to the recently
unemployed, and applying psychological research to improve air travel safety,
respectively.
Supporting In-Service Disaster -Related Training Opportunities and Mental
Health Services
Congress, like so many national organizations, local groups, and individuals,
has tried to react quickly to address the needs of the nation during these
extraordinary and unprecedented times. In response to the tragedies of September
11th, Senators Ted Kennedy (D–MA)
and John Warner (R–VA)—drawing upon a bill from last Congress introduced by
Senators Pete Domenici (R–NM) and Paul Wellstone (D–MN)—drafted
legislation to address the mental health needs of individuals affected by the
recent terrorist attacks. Entitled the "Post Terrorism Mental Health
Improvement Act," this legislation is designed to enable local communities,
through government agencies, local education agencies, and private service
providers, respond to mental health needs arising from a disaster.
In essence, the legislation continues to be a work in progress. After
discussions with various groups, including APA, an in-service training program
for mental health professionals focusing on victims of disaster and terrorism
was among the provisions included. Training grants would be made available
through the U.S. Department of Health and Human Services’ Center for Mental
Health Services to mental health professional societies or regional centers of
excellence to prepare mental health professionals for treating victims of
disaster and terrorism. As a means to ensure a pipeline of qualified mental
health providers with expertise in treating victims of disaster and terrorism,
PPO tried to encourage the bills’ authors to add a graduate education program
but was unsuccessful.
In an effort to help those most in need and move this legislation quickly,
the bill has taken a somewhat unique route towards passage. And still, even with
the needs that exist and the timeliness of the initiative, there are no
guarantees at this point that any of the provisions of this legislation will be
enacted into law.
Seeing the need for quick action to authorize and fund this program, Senator
Warner agreed to offer it as an amendment to the Defense Department reauthorization
bill. When that effort failed, an attempt was made to attach it to the Defense
Department appropriations bill. That was also unsuccessful. The
authors of the bill then decided to pursue the more traditional route for
consideration of legislation—shifting the arena to the authorizing committee
of jurisdiction—the Senate Health, Education, Labor and Pensions Committee.
(See the accompanying box for a brief description of these legislative
processes.) There, one of the bill’s authors and champions, Senator Kennedy,
who also happens to chair that committee, placed it on the agenda for the
executive session and, with support from other committee members, got the bill
favorably reported out of Committee on October 16. Because of the limited time
remaining this year and the unique work circumstances on Capitol Hill (e.g., one
of the Senate office buildings is still closed due to anthrax contamination,
displacing over half of the Senators and their staffs), this bill was broken
down in the hopes of gaining passage of smaller sections. Accordingly, the
training provision is now being considered as part of the House-Senate
conference on the reauthorization of the Elementary and Secondary Education Act.
If you are confused by this topsy-turvy process, do not be discouraged. The
legislative process on its best days is confusing—on its worst,
incomprehensible! During these difficult times and challenging circumstances,
members of Congress are striving to enact laws to create or expand existing
programs and to appropriate funds to respond to the call of a nation in need.
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Primer on the Legislative Process: Authorization and Appropriations
The general principle of the two-step authorization-appropriations process is
that first Congress enacts an authorization bill. Then Congress considers
appropriations measures to provide discretionary budget authority for agencies
and programs covered in the authorization act. Authorizing bills provide legal
authority and spending limits for federal programs and agencies; appropriations
bills actually allocate funds for those programs and agencies. Authorizing
legislation can take more than a year to complete, while appropriations
legislation must be approved annually.
The "Post Terrorism Mental Health Improvement Act" is an example of
legislation that breaks all the rules in terms of order and timing. It
illustrates what Congress can do when the focus of the legislation is of
immediate national interest.
Assisting the Newly Unemployed and Uninsured
The terrorist attacks of September 11th have
had a dramatic impact on the economy and access to health care services for
vulnerable populations. Congress is currently considering legislation to
stimulate the economy. PPO has been advocating on behalf of the bill’s
provision to provide health insurance coverage to laid-off workers.
The big picture. The September 11th
attacks increased uncertainty and apprehension in financial markets, which has
had a negative impact on consumption and investment as consumer and business
confidence has deteriorated. The negative effects on travel and related
industries are likely to spread to others. The November 2nd
labor statistics revealed the nation’s highest unemployment rate since
December 1996 and the largest one-month increase in 21 years.
In this economic downturn, many low-income women, including those who have
recently left welfare, are losing their jobs (i.e., "last hired, first
fired"). According to the Department of Labor, women comprise 62% of the
workforce in the service industries and just over half of all jobs in the retail
trades. These sectors have been the hardest hit and traditionally employ
low-income women, including those leaving welfare.
Unemployment inevitably leads to higher numbers of Americans without health
insurance, since over 40% of people losing or changing jobs become uninsured.
Not only are they more likely to delay or not receive needed medical care, they
are far less capable of paying other expenses. States also incur the costs of
providing health care for some of these and other uninsured persons through
their Medicaid programs. Even before September 11th,
17 states had announced budget shortfalls in public spending; and about 35
states, burdened by increasing costs and unemployment, witnessed Medicaid
spending that exceeded appropriated amounts.
Status of legislative action. Democrats and Republicans have agreed that
they should pass an economic stimulus bill; however, that is the extent of the
agreement. After weeks of negotiation, they are further apart than ever. The
House passed an economic stimulus bill on October 24th
by a very close vote of 216–214. On November 14th,
Senate Republicans blocked a Democratic-crafted bill from coming to a vote on
the Senate floor. The House bill consists primarily of tax cuts, while the
Senate bill is split between spending for laid-off workers and tax cuts. A group
of Senate centrists have also drafted a plan that essentially splits the
difference on a range of contentious issues. Lawmakers said that any deal
appears unlikely before mid-December.
Health provisions in House bill. PPO is particularly concerned about the
health provisions in the bill that passed the House. The principal provision is
an increase of $3 billion in funding for the Social Services Block Grant (SSBG)
for fiscal year 2002. Under SSBG, states are given funds to furnish services
that can boost self-sufficiency, prevent abuse and neglect, and encourage
community-based care for persons with long-term care needs, including children,
elderly and disabled individuals.
However, SSBG is simply the vehicle to provide funds for health insurance to
unemployed workers and their families rather than other SSBG services. We are
concerned that it would not help most workers who have been laid off and the
level of funding is only sufficient for a fraction of unemployed workers. Among
our specific concerns are the following:
• The bill contains no requirement that states establish any minimum
standards for the health insurance policies for which these funds could be
used. This could lead to the creation of low-quality private plans with high
deductibles and limited benefits, such as no provisions for mental health or
substance abuse treatment. In contrast, both Medicaid and State Children’s
Health Insurance Program (SCHIP) programs have federal standards for
comprehensive benefit packages, including mental health care.
• Under the bill, states would only be able to use the funds to provide
health insurance to unemployed individuals who have "sufficient recent
earnings" to be eligible for unemployment insurance. In all but a handful
of states, a laid-off worker’s earnings in both the current calendar quarter
and the preceding calendar quarter are not counted in determining
whether the worker has "sufficient earnings" to qualify for
unemployment insurance. This provision would disqualify large numbers of
low-wage workers who have recently entered the labor market, including many
low-income working mothers who have left welfare for work and are at high risk
for job loss.
• Finally, the increased SSBG funds will not be targeted to states with
the greatest need. Under the bill, the funds will be allocated among states
based on the share that each state’s population comprises of the national
population. By basing the allocation on population, a state’s levels of
unemployment, uninsured, or poverty will not be considered.
• Health provisions in the Senate bill (as reported out of Committee)
• PPO is pleased with a number of provisions in the Senate bill. One of
these provides a 75% subsidy for the Consolidated Omnibus Budget
Reconciliation Act (COBRA) program, which allows people to maintain their
employer-provided health insurance coverage for 18 months after they leave a
job, as long as they pay the premiums themselves. Yet, COBRA premiums are very
expensive: the average annual cost is $2,700 for individual coverage and
$7,200 for family coverage. The average unemployment benefit is $231 a week.
Therefore, only about 18% of workers who qualify to maintain their health
insurance coverage under COBRA actually can afford to do so. The Senate bill
gives states funds and flexibility to pay the remaining 25% for people with
very low incomes.
• The Senate bill also enables states to provide Medicaid
coverage for workers who are not eligible for the COBRA program. Most workers
previously insured through small businesses (under 20 employees) do not have the
option of COBRA when they lose or change jobs. Rapidly rising Medicaid costs are
pressuring a number of states to contemplate and/or implement a range of cost
containment strategies that could harm countless numbers of Medicaid
beneficiaries. A number of states are looking to reduce Medicaid at a time when
maintaining and improving health care coverage is sorely needed. Under the bill,
the matching rate for state Medicaid coverage would be increased to make it
easier for states to maintain coverage.
As you can see, the legislative situation is very fluid. PPO will continue to
advocate on behalf of vulnerable populations as the process continues.
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Applying Psychological Science to Enhance Air Travel Safety
One of the goals of our office is to make sure that sound science is used to
inform public policy. It is often a struggle to demonstrate the importance of
this work to busy graduate students and their faculty mentors. But what if you
had to think about a science policy debate every time you boarded a commercial
airliner? Unfortunately, now you do.
Concerns about how weapons used in the September 11th
hijackings were secreted on to four airplanes raised broad questions about
airport and aircraft security. Whether or not the hijackers smuggled them
through a fixed checkpoint or worked with accomplices in the ramp/catering staff
may never be known. But a 20-year history of poor performance by airport
security screening personnel naturally focused attention on that workforce as
the weakest link. By now you probably know that both the House and Senate
aviation security bills (H.R. 3150 and S. 1447, respectively) sought to optimize
the effectiveness of security screening operations but differed over how to
manage the security-screening workforce. However, as APA indicated in letters to
House and Senate conferees, a wealth of research suggests that rather than
focusing on the managing entity (federal vs. private contractors) the focus
should be on proven methods for selecting, training, testing, and supporting the
right individuals to do the job. In the end, the compromise legislation called
for federalizing the workforce, and on November 19, the President signed that
bill into law.
That bill, the "Aviation and Transportation Security Act" creates a
new autonomous division, the Transportation Security Administration, within the
Department of Transportation. A new Deputy Secretary will set standards for
selection and retention of a workforce with a history of 100–400% annual
turnover nationwide. What contributes to that turnover and why do these
individuals perform so poorly? Questions about who is best suited for a given
job setting and how to configure the work environment to optimize human
performance cut across several domains of scientific psychology (e.g.,
industrial organizational, experimental engineering, and human factors).
In fact this work goes back to World War I following the first massive
national call to arms. When the Army needed a way to determine what these new
enlistees could do, they created the first aptitude test (the Army Alpha test),
so that new recruits would receive appropriate assignments. Conducting task
analysis to determine the knowledge, skills, and abilities required to do a
given job and then using that information to inform personnel selection
standards has been used in several recent legislative and regulatory debates.
For example, APA provided guidance on the development of Uniform Guidelines
on Employee Selection Procedures (1978), the Americans with Disabilities Act
of 1990, and the Civil Rights Act of 1991. More recently APA co-authored the Standards
for Educational and Psychological Testing (1999), and Division 14 published
the Principles for the Validation and Use of Personnel Selection Procedures,
both widely accepted references used to ensure that employee candidates are
suited for a given employment setting.
So what can science say specifically about the selection and performance of
screening personnel? Doug Harris, PhD, an APA member and former President of the
Human Factors and Ergonomics Society, authored a chapter as part of a report for
the National Research Council (NRC) entitled, "Commercial Aviation
Security: Integrating People and Equipment to Improve Threat Detection."
The report was due to be published by the National Academy Press this year but
has been pulled from production presumably because elements of the report have
been reclassified in the interests of national security. However, Dr. Harris
shared his human factors analysis with PPO and it has become the centerpiece of
our lobbying efforts as Congress considers how to provide oversight for the new
workforce it has created. The chapter makes several important points about why
security-screening personnel perform poorly and how to optimize the
effectiveness of the airport security screening system.
Screening personnel have a very difficult job to do under the best of
circumstances. They are required to detect infrequent events (threatening
objects) under conditions of sustained vigilance. Even those who are highly
motivated and show great aptitude for these tasks do not perform well under
these conditions. However, add to that other factors including low morale
brought on by low pay, stressful working conditions and harassment and it is no
surprise that the performance of these individuals is eroded even further.
Although personnel selection is critical, security system design must take
into account the optimal role of the human and the machine. As indicated above,
humans are poor monitors but have unique capabilities, including pattern
recognition, abstract reasoning, and spatial visualization. As such, they are
best suited to resolve alarms triggered by automation—humans can and should
perform those tasks that still defy automation. Part of the solution, then, will
involve retrofitting existing systems and employing human-centered design
principles to allocate the appropriate functions to the machine and the operator
of new systems. The Department of Transportation doesn’t have to reinvent that
wheel; a good model of this process is the MANPRINT program within the
Department of Defense.
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What if we just paid the screeners more money? Much has been made of the fact
that security screeners are poorly paid and the assumption is that better pay
would improve performance. In fact, there is a poor relationship between wages
and performance. However, better wages may decrease turnover and decreased
turnover may allow other training and motivational factors to take effect to
improve performance. Dr. Harris makes the distinction between factors that will
attract and keep people on the job (e.g., working conditions, status, and job
security) versus those that will improve job performance (e.g., design of the
job, feedback and recognition, and opportunities for growth).
So while a great deal of research about personnel selection, the design of
the human-machine interface, and constructing a supportive work environment
should be helpful to this administration, getting the right people to pay
attention to that research may be a daunting task. The FAA has a long history of
paying lip service to human factors research, most recently in a high profile
case of botched acquisition called STARS. The Standard Terminal Automation
Replacement System (STARS) was a disastrous attempt to create state-of-the-art
displays for Air Traffic Controllers using off-the-shelf hardware and software
modules. The failure to integrate basic human factors design elements into these
new systems leads to hundreds of millions of dollars in cost over-runs and years
of implementation delays. Similar delays in the installation of new explosives
detection technology and sub-optimal screening rates for checked baggage suggest
that similar problems with the human-machine interface may bedevil security
screening operations for some time to come.
But let’s end on a high note. The "Aviation and Transportation
Security Act" authorizes $50 million per year for security research for
2002-2006 (approximately doubling the allocation over previous years). Getting
the appropriators to follow through with the actual funds will be a job for
those of us in PPO. In any case, we’ll have some help along the way. We are
very fortunate that APA member Deborah Boehm-Davis, PhD—Professor of
Psychology at George Mason University—last month assumed the Chair of the FAA’s
Research, Engineering, and Development Advisory Committee, which reviews FAA’s
programmatic research priorities. Hopefully, with a human factors researcher at
the helm, we can invigorate the Administration’s appreciation of scientific
psychology and, in so doing, rebuild public confidence in the safety and
security of our national aviation system.
We encourage APAGS members to become engaged with our Public Policy Office
this coming year to further federal policy initiatives on behalf of psychology.
For more information about PPO, visit our Web site at: www.apa.org/ppo or
contact us at (202) 336-6062.
