On Your Behalf

To determine which treatments are most effective for both mental and physical illness, researchers must evaluate the behavioral, psychosocial and medical interventions individually and in combination, according to APA President James H. Bray, PhD, who testified at an Institute of Medicine Committee on Comparative Effectiveness Research Priorities public meeting March 20. "Even when strictly medical treatments are compared," said Bray, "it is important to expand the range of outcome measures to include behavioral and psychological outcomes, such as quality of life and adherence to treatment protocols."

Bray also emphasized the need to evaluate promising new models of care, such as using integrated, interdisciplinary behavioral and medical teams in primary-care settings. He also urged researchers to consider the effectiveness of health interventions across the lifespan and for different minority and gender groups.

The IOM committee is gathering such testimony as part of its study to recommend national priorities for comparative effectiveness research to the Secretary of Health and Human Services and Congress for $400 million from the American Recovery and Reinvestment Act of 2009, often referred to as the economic stimulus package. APA also submitted testimony to the Agency for Healthcare Research and Quality on April 2 to inform funding decisions for $300 million in comparative effectiveness research that the stimulus package allotted to that agency.

APA and the APA Practice Organization joined more than 30 organizations in signing a letter March 9 urging Congress to support the administration's proposed $634 billion set aside in a health-care reserve fund over the next 10 years. "Our nation cannot afford to wait," said the letter. "We will be looking to you to take the additional steps needed to deliver on the commitment that the president has made to the American people." The letter was sent to House and Senate leaders, the budget committees, and the congressional committees overseeing health-care reform.

Improving the mental health system for children and adolescents should be a top priority in health-care reform, according to a March 11 letter APA and several other organizations sent to President Barack Obama and members of Congress. Among its recommendations, the letter calls for the nation's next health-care system to include family-centered infant and early childhood mental health services since "there is an explosion of knowledge that calls attention to the importance of early relationships in setting the stage for a child's social and emotional development and mental health." The letter also emphasized the need to eliminate disparities in mental health status and mental health care. Under today's system, only 13 percent of minority children receive mental health care services, and often those services "tend to be ineffective and of low quality," the letter said. For more information, contact APA's Daniel Dawes.

The APA Practice Organization is working to ensure that health-care reform recognizes the contributions of non-physician providers. In a March 11 letter, the APA Practice Organization joined with the 10 other non-physician provider organizations in the Patient Access to Responsible Care Alliance (PARCA) in asking to meet with congressional leaders working on health-care reform. "We are committed to improving quality and finding a health-care solution that, in the best interests of the patient, assures access to and equitably reimburses the contributions of all types of recognized health-care providers," said the letter. Other members of PARCA include the American College of Nurse-Midwives, American Occupational Therapy Association, American Optometric Association, American Physical Therapy Association, and the National Association of Social Workers.

APA has endorsed legislation that would give workers 12 weeks of paid family leave. The Family Leave Insurance Act of 2009, introduced March 25 by Rep. Pete Stark (D-Calif.), would give paid benefits to workers who need to take time off to care for an ill family member, a new child or because of their own illness. The legislation builds on the success of the Family and Medical Leave Act of 1993, which has provided job security to more that 100 million Americans who have taken family leave. For more information on APA's endorsement, contact APA's Daniel Dawes.

APA worked closely with the office of Rep. Linda Sanchez (D-Calif.) on The Bullying and Gang Reduction for Improved Education Act of 2009. Introduced March 18, the bill would allow certain funding streams at the U.S. Department of Education to be used for bullying and gang prevention efforts, as well as to implement threat assessment protocols. This legislation represents a longstanding commitment for APA and builds on the "APA Resolution on Bullying Among Children and Youth." APA worked closely with Sanchez's office to ensure that the bill included psychologists, threat assessment protocols and special protections for youth at risk for being bullied. According to current research, youth with disabilities, those who are overweight and those who identify as lesbian, gay, bisexual or transgender are more likely to be bullied. For more information, contact APA's Micah Haskell-Hoehl.

As a founding member of the Collaborative for Enhancing Diversity in Science, APA sponsored a congressional briefing March 12 on the challenges the National Institutes of Health, the National Science Foundation and others face in creating a diverse scientific workforce. In the past eight years, for example, less than 2 percent of research project grants supported African-American scientists and less than 4 percent were awarded to Hispanic scientists, according to Acting NIH Director Raynard Kington, MD, PhD, who spoke at the briefing. In response to the lack of progress in increasing representation of ethnic-minority scientists, NIH is taking a closer look at the data to see what factors are critical to the long-term success of research scientists from diverse backgrounds, Kington said. Also speaking at the briefing, Wanda Ward, PhD, acting director of NSF's Education and Human Resources Directorate, agreed on the need to diversify the scientific workforce, including increasing the representation of women and people with disabilities. She discussed NSF's Innovation through Institutional Integration Program, which encourages institutions to think creatively about integrating across NSF-funded projects.

APA, partnering with the Human Factors and Ergonomics Society and the Federation of Behavioral, Psychological and Cognitive Sciences, nominated five psychological scientists with expertise in human factors to serve on either of two new committees created by the American Recovery and Reinvestment Act. The two committees were established to develop an improved electronic infrastructure, which the Obama administration sees as an important predicate for health-care reform.

The two committees are Health Information Technology (HIT) Policy and HIT Standards. The latter will make recommendations to the national coordinator for HIT on standards, implementation specifications and certification criteria for the electronic exchange and use of health information. The nominees are: Sara Czaja, PhD; David Kobus, PhD; Donald Norman, PhD; Jacob Seagull, PhD; and David Woods, PhD.

Reform must recognize the mind-body connection

As the nation works to revamp its ailing health-care system, lawmakers must recognize that the mind and body are inextricably linked, says said APA's Katherine Nordal, PhD, Executive Director of APA's Practice Directorate. Nordal testified at a March 27 congressional briefing and press conference that APA and the APA Practice Organization co-sponsored with the National Academies of Practice. The event called for a health-care system that features interprofessional, accountable care that improves access for all.

"Too often when a patient seeks treatment for a chronic disease, such as diabetes, obesity, cancer or a heart condition, that treatment fails to take into account the patient's emotional and psychological needs," said Nordal.

In fact, she pointed out, most of the leading causes of death are related to behavioral factors. "Psychology, as the science of behavior, has much to contribute to improving the health status of our nation [and] is ready to work with Congress and the Obama administration."

APA contends that an improved health-care system is one that recognizes psychology, with its scientific knowledge base and professional applications, as fundamental to health and the health-care system. APA and the APA Practice Organization established eight priorities for reform that include recommendations related to integrated care, health promotion, mental health workforce development, the inclusion of quality psychological services in all benefit plans, enhanced consumer involvement, strong records protections in health information technology, increased federal funding for psychological and behavioral research and training, and the elimination of health disparities (see "A new vision for American health care").

"We want to make sure psychological services are included in every facet of health reform—in primary care, prevention and benefit packages," she said.

The National Academies of Practice represents 10 health professions: psychology, dentistry, medicine, nursing, optometry, osteopathic medicine, pharmacy, podiatry, social work and veterinary medicine.