It Has Been an Exciting And Productive Time
Pat DeLeon, PhD, JD

National Register of Health Service Providers in Psychology, May, 2004
Three decades ago, Al Wellner and his colleagues set out on a quest to provide the Congress and the public with a credible way to determine who should be considered qualified to provide psychological care. Al invited me to participate in those early efforts and I was extraordinarily impressed by his dedication, vision, and compassion. They were true trail blazers. They cared about the profession and the individual practitioner. They appreciated we were a maturing profession whose educational standards were evolving, rather than set in stone. They were charting a future where organized psychology feared to tread. Over the years, the National Register has maintained that impressive heritage and institutional integrity at times, in very rough waters. In fact, the only time I can recall ever walking out of an APA Council meeting (because I did not feel I could be objective) was when the National Register was being heatedly debated. My sincerest appreciation to Judy Hall and her Board for their collective decades of service. All of psychology has benefited from their dedication to our future. Mahalo.

From its inception, the National Register has been intimately involved in shaping our nation’s health (and mental health) policy, although it may not have conceptualized its efforts in such a fashion. When one is on the front line of a heated battle, it is often hard to see the bigger picture. One of the realities of being involved in the public policy process is that one really never knows what agendas will evolve. One can never safely predict today’s priority or potential crisis. One day this spring, for example, the US Senate held comprehensive hearings on Department of Defense health care initiatives, where mental health readiness for the war was a high priority. That same day, another committee held hearings examining mental health in children and youth, focusing on issues throughout the developmental process. And, a third public hearing addressed promoting a healthy marriage. Over time one learns that to be successful in the public policy (i.e., political) process, one must be committed to the long haul. Psychology can not thrive in an isolated professional silo. Instead, we must become more interdisciplinary oriented and appreciate that our profession is but one element of a highly complex system dedicated to the cost-effective delivery of health care services and health professions training. Equally importantly, we must understand that the behavioral sciences are the key to ensuring high quality health care for all Americans. And that we, above all others, must promote that agenda.

From my public policy perspective, one of the most critical agendas facing psychology today is the necessity of being responsive to the unprecedented advances that are evolving within the communications and technology fields. For more than a decade, the bipartisan House-Senate Steering Committee on Telehealth and Healthcare Informatics has sought to ensure that those involved in shaping our nation’s health care policies are systematically informed about their relevance for health care delivery. The Institute of Medicine (IOM) has consistently noted that health care delivery (and health professions training) in our nation has been relatively untouched by the revolution in information technology that has transformed nearly every other aspect of our society. Currently, the time lag between the discovery of more efficacious forms of treatment and their incorporation into routine patient care is unnecessarily long, in the range of 15 to 20 years and even then, many medical technologies are being used inappropriately. And, although 70-100 million Americans utilize the Internet to obtain health information, the IOM further reports that 46 percent of American adults (60 million people) are functionally illiterate in dealing with health. This is a problem which is as profound as any new infectious or chronic disease, but which is not spoken of by patients and is not appreciated by policy makers and the general public. Psychology is one of the nation’s learned professions and, as such, must provide proactive vision and leadership in shaping the interface between technology and psychological care. It will not be easy; however, it must be done.
The President of the Sloan Foundation recently reflected upon lessons they have learned from their internet education initiatives. To date, 47 schools of the Sloan Consortium have provided more than 4,000 faculty-semesters of teaching experience and more than 100,000 enrollments. I would suggest the President’s thoughts are highly analogous to the debates today within psychology surrounding the nuances of telehealth care. “In 1989 there was no commercial Internet. It was hard to get people interested in learning over networks or to even understand what learning over networks meant or could mean.... In actual practice the traditional classroom has proven to be quite resilient, which is a quality we should respect.... (W)hat are the elements of higher education, as we know them....? First there is the Professor.... A second element is the course material.... A third element is classmates. They help both in and out of class. They provide an element of shared experience, and they are people with whom both the course content and what the professor meant can be discussed between classes. They also provide important emotional support. Today it is possible to provide some form of these elements electronically, without a campus, without a classroom, and without the necessity for the learner to be at some fixed place or time when a lecture is being given.... It is not obvious that this process can really educate people or that people will want to learn this way. It is a real question Will people really learn this way?...“(W) can do more than speculate, there is a real experience base to work from.... (W)e are confident that the students are not only taking courses, they are actually learning. Many comparisons of learning outcomes have been made.... Usually the learning outcomes for the different sections are indistinguishable.... We do know enough today to say that a new technology has arrived on the higher education scene and that it works.... For those who teach... teaching will be different. How different depends.... Interaction with the students is also different.... New technologies usually succeed first in a niche
where they have special advantages.... After a while in a new technology industry, especially if there are economies of scope or scale in what is being provided, there is a shakeout... and the industry takes on a more stable form. Entry of a new technology into an industry often brings in new providers.... One effect of this new learning technology is likely to be more competition at a national level.... There is also, and this is important, for the first time, the possibility of more comparable quality.... There can also be new combinations of institutions.... (W)e cannot predict what will actually emerge, but the scene will change.... And even beyond the quality issue, it is usually unwise to ignore a new technology that is having an impact in your industry. And I think that in this case understanding is more likely to come from activity rather than study.... Today it is becoming possible to make learning something that can be done at a time and place of your own choosing, it can be done at home, but without the isolation of solitary learning.... By making learning outside of the classroom less heroic, we can make it what it ought to be, an ongoing part of ordinary life.” Are the challenges of telehealth for clinicians really qualitatively different than those inherent in distance learning for our educators?

Aloha, Pat DeLeon, former APA President