State Leadership Conference

More than 600 participants from 60 states, provinces and territories gathered in Washington, D.C., March 5-8 for the APA Practice Organization's 2005 State Leadership Conference, sponsored by the APA Practice Organization--a group affiliated with APA. The conference focused on increasing national attention to the connection between mental health and physical health and the window of opportunity that attention creates for psychology.

The conference, an annual event that helps set the Practice Directorate's agenda at the federal and state levels, brought together a broad range of professionals interested in advocacy to discuss strategies and directions for practitioners. Each year, state delegations meet during the conference, coordinate their goals with those of the APA Practice Organization and share practical information about accomplishing professional psychology's advocacy agendas.

At this year's conference, APA Executive Director for Professional Practice Russ Newman, PhD, JD, said the theme, "Health and behavior: Taking psychology back to the future," emphasized that now is the time to highlight psychologists' traditions and innovations as health-care practitioners because the health-care industry and the general public are finally understanding and acting on the mental health-physical health link.

"A future health-care system that relies on connections between behavior and health reaches squarely back into psychology's past," Newman said at the opening session. "What policy-makers and the public are now just starting to realize, psychology has known for years, if not decades: The research, the knowledge base and the technologies to change behavior in ways that benefit people's health do exist, and much of the research, the knowledge base and the technologies are psychology's work."

Newman urged practitioners, in their work with patients and other professionals, to view themselves as "experts in behavior."

"This conception of ourselves is not intended to replace our practice as mental health and health professionals, but instead to encompass and enhance it," he said.

There is no clear single way to incorporate psychologists' knowledge of behavior into the changing health-care marketplace, he added. However, Newman identified several innovative strategies individual practitioners and state associations can pursue to achieve more psychology involvement in health care. They can:

  • Proactively reach out to people with health-risk behaviors, such as poor diet, lack of exercise, smoking and alcohol use, to work with them or educate them on behavior change.

  • Tailor behavioral health outreach messages to the needs of a range of different people, conditions and motivation-to-change levels.

  • Make psychological treatments more accessible by integrating them directly into primary care and making them home based.

Agenda progress

On the legislative front, the Practice Organization and state associations long have worked to propel integration of psychology into health care, Newman said, and in the year since the last State Leadership Conference that work produced many successes, including:

  • Prescription privileges (RxP). Last May, Louisiana became the second state--joining New Mexico and the territory of Guam--to enact a prescriptive authority law for psychologists. And in January, both Louisiana and New Mexico successfully completed implementation of the laws, when final rules and regulations became effective.

This year, legislative work to establish privileges will continue in Hawaii, Tennessee, Connecticut, Illinois, Oregon, Wyoming and Missouri. In New Mexico, efforts to improve the law's current definition of "psychoactive medication" will continue.

  • Improved state laws. West Virginia and Georgia joined Florida in enacting good-faith immunity laws for court-appointed psychologists to protect them from litigation from parents upset with the outcome of a custody evaluation. The New Jersey Supreme Court adopted rules allowing a psychologist to replace one of the two physicians previously required for capacity determinations in guardianship hearings.

Missouri passed a comprehensive mental health parity law--becoming the 19th state to do so--and Washington state is expected to follow suit later this year. Washington state also revised its licensing law to permit both years of supervised practical experience leading to licensure to occur predoctorally. And in Colorado, psychologists successfully fought back an attempt to reinstate an omnibus licensing board.

  • Increased acceptance of CPT codes. Somewhat slow to gain widespread use after their 2002 acceptance, Medicare's health and behavior Current Procedural Terminology (CPT) codes are catching on. The number of psychological health and behavior claims to Medicare increased almost 400 percent from 64,000 claims in 2002 to more than a quarter of a million claims in 2003, Newman said. And Medicare reimbursements for psychological services skyrocketed from $1.56 million to $6.1 million in a year's time, according to the U.S. Centers for Medicare and Medicaid Services.

A big year ahead

Though it failed to pass in 2004, the Paul Wellstone Mental Health Equitable Treatment Act gained significant momentum in the U.S. Congress, Newman noted. Even though the broad-based national parity bill didn't make it to the floor of either house, inclusion of parity in both major parties' 2004 presidential platforms and the support of hundreds of organizations and 70 U.S. senators and 249 representatives, who co-sponsored the bill, have given the issue prominence and offered reason to be optimistic, Newman said.

"I believe this to be the year that discrimination is outlawed, and full parity for mental health finally becomes this country's law," he said.