Strategies for winning Rx privileges

Conference speakers discuss how they convinced lawmakers and others to join in the pursuit of prescriptive authority

By Rebecca A. Clay

Before prescribing psychologist Major Debra Dunivin, PhD, came along, the 64-year-old woman with bipolar disorder hadn?t been too happy about her treatment.

In the past, she said, her psychiatrist would come in, ask about her medication and breezily tell her, 'See you next month!' Dunivin was one of the first health-care providers who actually talked to her, the woman confessed.

'Prescribing psychologists aren?t public health hazards,' said Dunivin, who now works at the Eisenhower Army Medical Center in Ft. Gordon, Ga. 'We?ve earned the gratitude of our patients and the respect of our colleagues.'

A graduate of the U.S. Department of Defense psychopharmacology demonstration project, Dunivin shared her experiences as one of the nation?s few prescribing psychologists during a plenary session called 'Improving care for those we serve: prescriptive authority and public policy.'

The session was chaired by psychologist Patrick H. DeLeon, PhD, JD, chief of staff for Sen. Daniel K. Inouye (D-Hawaii).

Practical tips

The session?s speakers gave the audience strategies they could use in the battle to win prescription privileges for psychologists.

Chris Flammer, legislative consultant to California State Sen. Richard G. Polanco, boiled his strategy down to a single message: Prescription privileges will increase underserved populations? access to mental health care. Sen. Polanco has introduced prescription-privilege bills in the California legislature for the last four years.

Flanner admits he was skeptical when psychologists first approached him on the issue. But when he learned that 14 of the state?s 58 counties had no psychiatrists and that 10 had fewer than two, he became convinced of the importance of granting psychologists the right to prescribe. Sen. Polanco?s current bill would require prescribing psychologists to spend at least three years working with underserved populations, which can be found in rural, suburban and urban areas.

Greg Frost, JD, a lobbyist for the Louisiana Psychological Association (LPA), offered additional tips:

? Make your bill as reasonable as possible instead of loading it up with throwaways you?re not committed to.

? To avoid a fight over what kind of training is adequate, get legislators involved in establishing training criteria from the very beginning.

? If you don?t have hundreds of thousands of dollars for a media campaign, rely on grassroots activities and ask psychologists to meet with their legislators.

? Neutralize some of the opposition by enlisting the support of individual physicians.

Thanks to these strategies, Louisiana became the first state to get a prescription-privileges bill out of a full committee.

In fact, Frost is convinced LPA lost only because it had to divide its attention between promoting the prescription-privileges bill and fighting a bill that would have made licensed professional counselors the equivalent of psychologists. 'Fighting a two-front war didn?t work for Germany, and it didn?t work for us,' said Frost. 'I was disappointed but proud that we were taken seriously.'

The question of which should come first?training or legislation?dominates many discussions about prescription privileges. For Cal VanderPlate, PhD, the two go hand-in-hand.

'It?s difficult to get busy psychologists to commit to training without the prospect of being able to use that training,' said VanderPlate, chair of the prescribing privileges committee of the Georgia Psychological Association (GPA). 'And it?s difficult to get the legislature to pass a bill without having anyone trained to do the prescribing.'

GPA has solved the problem by taking a two-pronged approach. While the association has pushed for legislation, it has also put together a training program that is consistant with APA?s model curriculum. The program is being offered through Georgia State University and the University of Georgia, followed by a one-year practicum. The program uses a model based on psychology?s values and principles rather than what VanderPlate calls an 'off-the-shelf medical model.'

Acting as both registrar and dean, GPA tells psychologists how to enroll, plans the curriculum and will eventually certify graduates to the licensing board. The first students began the waiting-list-only program last September. By next September GPA hopes to have about 120 psychologists enrolled. That, said VanderPlate, represents a mandate for the legislature to pass a prescribing-privileges bill.

'If we weren?t pushing for legislation, our students would be educational speculators,' said VanderPlate. 'Because we?ve made a commitment to them, they?re instead educational pioneers.'

Rebecca A. Clay is a writer in Washington, D.C.