In 1995, APA's Council of Representatives officially approved a resolution making prescription privileges for psychologists a major policy directive for the association. Since then, advocates for prescription privileges (RxP) have taken the ball and run with it. Progress isn't measured only by passing legislation. In the last seven years, several major developments have occurred:
31 RxP task forces have been formed in the states.
13 states have introduced RxP legislation.
11 training programs--three nationwide and eight state--have been created.
In 1998, Guam passed legislation that allows psychologists to prescribe in collaboration with physicians.
Perhaps as testament to how far motivated advocates can push the issue, after only five months of hard work, the Arizona Psychological Association's (AzPA) RxP task force scored big when it was granted a hearing before its legislature's health committee on Dec. 5 to determine whether the scope of practice for psychologists could be expanded to include prescription authority. AzPA negotiated beforehand that there would be no vote called during the hearing, but that after the legislative session ended, an ad hoc committee would be formed. "It was a strategy," says Patricia Johnson, PhD, chair of AzPA's RxP task force.
Facilitated by the chair of the Arizona House Committee on Health, the ad hoc group will bring stakeholders together to "hammer out differences and come up with a bill," says Johnson. "Because we've worked so hard to build relationships over the years, some legislators are willing to say 'Why don't we take a look at this?'
"We did so well in the hearing," she notes, that "we came out with more support than we had when we went in." Though the Arizona legislature may not draw up a bill this session, RxP advocates will work behind the scenes to build support until the time is right.
"They really made remarkable progress," says Rochelle Jennings, APA's prescription privileges coordinator.
Education is key
Legislative strategies, such as AzPA's, are only part of the RxP game plan. Before bills can be written, advocates have to spread the word about RxP.
"Getting psychologists on board was one of our most important efforts," says Dee Yates, PhD, a practitioner in San Antonio, Texas, co-chair of the Texas Psychological Association (TPA) RxP task force, and TPA's president-elect. "Initially, we had a lot of resistance from within the field. But as we started educating people, it got better."
To reach members, articles illustrating the benefits of prescription privileges were published in TPA publications, and major presenters, such as APA Past-president and outspoken RxP advocate Pat DeLeon, PhD, were invited to TPA's annual convention. Experts on both sides of the issue even held debates at conventions.
After learning more about RxP, most psychologists in Texas were convinced to support it. The sentiment on prescriptive authority in Texas is about the same as what national surveys have found. "About 70 percent [of the field] really goes for it," Yates adds.
In Washington state, Brad Chang, PhD, who spearheaded a revitalization of the association's RxP task force, says that they're in the "information-gathering stage," like other state associations. The Washington Psychological Association sent out a survey to 1,500 state psychologists to assess how much they know about prescription privileges, their interest in RxP training and their level of support for the issue.
"We're moving conservatively and slowly," concedes Chang. "There is interest, but not everyone is supportive yet. It will take lots of education."
Illinois Psychological Association (IPA) President Marlin Hoover, PhD, says even if not every psychologist will seek RxP training, "practicing clinicians know it will be very helpful to them and their patients."
IPA has hired Lynda Behrendt, PsyD, RN, to move the initiative forward. "She has extended the number of psychologists in the network and developed materials and programs to educate psychologists," Hoover says. This dedication of human resources may have surprised some, considering Hoover wasn't initially convinced of the merits of prescription privileges for psychologists.
"The effort has been brewing here for 10 years. For a lot of us here in Illinois, we had to see the evidence that we could be trained to do this safely and then we decided to advocate for it," he says.
Convincing the public of that is also key to securing prescription privileges. "We have to work with consumer groups and get their support," says Chang. That's an uphill battle considering "a lot of people don't understand the difference between psychiatry and psychology," notes Yates.
In Illinois, Hoover and others are raising money for a public relations campaign. "Our major message is that psychologists can be trained to prescribe medications safely and effectively," he explains. "There's a need for well-trained providers for mental health medications. It's in the best interest of the public to allow the doctors of mental health that know patients best to prescribe those medications."
The RxP task forces across the country are also spending considerable time educating legislators on the issue.
"We've distributed audiotapes explaining what we're asking for," says Hoover, noting that the tapes have proven to be a successful communication tool for legislators who often travel long distances to the capital.
Most task force members also rely on experienced lobbyists to work with the legislature. In Texas, "we moved to a high-powered lobbyist who works for us and other groups too," says Yates. Advocates also take advantage of state legislative days, where psychologists receive training from a lobbyist and then take to the capital to spread their message.
And dedicated RxP advocates also ride the legislative fund-raising circuit, says Arizona's Pat Johnson. "People don't understand the networking that goes on at fund-raisers. We were everywhere and everyone began to see us," she says. Sometimes, she and others admit, success depends a lot on who you know.
For Johnson and Hoover, getting a hearing is a major win in the push for prescription privileges. For other task force members, winning over psychologists is a step toward success. Many states measure their success by the development of training programs in psychopharmacology.
In Texas, Georgia, Louisiana and New Mexico, training programs have been the result of task force members' tireless efforts, says APA's Jennings.
In Texas, task force members put training at the top of their agenda. In the late 1990s, two programs were developed. Now more than 100 psychologists have been trained to prescribe there.
In Georgia in 1996, Linda Campbell, PhD, of the University of Georgia, made cold calls to university programs to get the RxP training up and running. "We knew it would be good to get the program off the ground and it would be a good lobbying component to say we were successfully carrying out the curriculum," she says.
"Most university systems were shying away from the program in other states," she notes. But in Georgia, the cold calls and legwork paid off. Georgia State University and the University of Georgia came together to develop a continuing-education program. Faculty members from neuropsychology and pharmacy departments teach the courses. "We have four classes, two have graduated and several have passed the exam," says Campbell.
And, as Marsha Sauls, PhD, past-president of the Georgia Psychological Association, notes, trained psychologists make the most convincing advocates. "We try to really involve our graduates of the training program and keep them prominent in our legislative efforts," she says. In Texas and other states, psychopharmacology students and graduates pledge necessary financial resources for legislative efforts.
For the most part, RxP task forces are small groups of dedicated psychologists, as is the case with most other association task forces. "It's been my life for five years," says Michael Schwarzchild, PhD, chair of the Connecticut Psychological Association's RxP task force. "We have a core of about five or six folks with a keen interest," he adds.
Their efforts are often bolstered by financial support from APA. From 1996 to 2000, APA's Committee for the Advancement of Professional Practice awarded substantial grants to state associations for their RxP efforts.
Though the labor is long, the work keeps up. "We've made no pretense this would happen immediately," says Hoover. "We intend to keep after it until it happens."
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