State leaders network toward goals

Psychologists look to networks to maximize their effectiveness.

By Lisa Rabasca
Monitor staff

Networks--organizations or individuals who work together on a shared goal--are better suited to addressing health-care reform than are traditional hierarchical organizations or marketplace forces, according to Russ Newman, PhD, JD, APA's executive director for practice.

"Networks are more flexible and effective than hierarchies, more invested in the public interest than markets and more effective in responding to changing conditions than either," Newman said during the opening session of the 1999 State Leadership Conference in Washington, D.C. And, he said, networks are expected to become the preferred organizing structure in the 21st century.

APA itself is gearing up for the next century by integrating a number of networks into its structure, he said during a recent interview. These networks will focus on reforming the health-care system through federal legislation, state legislation, public education, business and legal activities.

"If we're going to be maximally effective, we need to make use of all the kinds of advocacy areas that exist," says Newman, whose goal is to create "a network of networks" that would get the 60,000 practicing psychologists in the United States and Canada working together in an orchestrated way to improve health-care.

"With all the various diverse pieces of our discipline working together, we are going to be a heck of a lot more powerful than those parts all working on their own," Newman says.

Years ago, he notes, APA could accomplish most of its goals by simply targeting Congress and state legislatures. Today, the organization needs to look beyond legislation to achieve its objectives.

"You need to be able to influence the public, purchasers of health care and the courts to leverage and push health-care changes in one direction or another," Newman says.

Using a coordinated strategy

His idea of a coordinated strategy is beginning to come together in the work of practitioners involved in legislative, public education, business and legal networks now advancing APA's health-care reform agenda. Last year, for example, they participated in an orchestrated strategy to promote federal patient-protection legislation. The grassroots Federal Advocacy Network, which has been working with federal legislators since the mid-1980s, encouraged lawmakers to support a bill that would amend the 1974 Employee Retirement Income Security Act to allow certain patients to sue their managed-care company for inappropriate denial of treatment or inadequate care. A network of Public Education Campaign coordinators in each state then reinforced that effort by helping to inform the media about problems with the health-care system and the needs of patients prior to the November congressional elections.

Meanwhile, the activities of two other networks provided further support for federal patient-protection legislation. The Business of Practice continued to make inroads in educating the business community--which has historically opposed health-care reform--about the benefits of providing comprehensive mental health care. And, a developing legal network filed lawsuits in California and Virginia against managed-care companies that are, they charge, interfering with patient treatment.

Similarly, APA used its networks to promote mental health parity. Practitioners in the Federal Advocacy Network urged the 105th Congress to support equal benefits for mental and physical health. And, providers in the Business of Practice Network supported that effort by meeting with the business community to discuss how to provide equal and affordable mental and physical health benefits.

These efforts are just the beginning, says Newman, who would like to see APA use the federal legislation, public education, business and legal networks more often. "You can have all these networks working but if they're working on different things, they're not maximizing their effectiveness."

Creating the 'network of networks'

APA began developing its networks in the mid-1980s, when it established the Federal Advocacy Network. Members of this network work with their federal representatives on proposed legislation. Each state, a few provincial psychological associations and a number of practice divisions have federal advocacy coordinators who direct member activities.

"The purpose of the network is to get people activated fast when there is a vote on federal legislation, and to provide expertise to APA staff or a congressman on legislative issues," says Marilyn Richmond, APA's assistant executive director of government affairs in the Practice Directorate.

The success of the Federal Advocacy Network led to the creation of other networks. As APA's mission has expanded, the organization has asked more psychologists to help advocate for health-care reform. About four years ago, the organization began developing the Business of Practice Network because the marketplace was becoming a larger force in the health-care debate.

"We needed to influence employers and purchasers of health care and we wanted to develop a number of psychologists who would understand the economics and language of the marketplace," says C. Henry Engleka, APA's assistant executive director for marketing in the Practice Directorate. APA brought in consultants to train psychologists to talk with employers about the advantages of providing mental health benefits. Today, the network has nearly 50 members.

Similarly, APA developed the Public Education Campaign network in 1996 to help consumers understand psychology's role in health care. "Without the consumer, we would not have the critical mass needed to impact the system and create change," says Jan Peterson, APA's assistant executive director for public relations and communications in the Practice Directorate. Currently, that network has nearly 60 members.

The legal network is the smallest, with only three members--representatives from New Jersey, California and Virginia--where lawsuits were filed by states against managed-care companies. However, Newman says he would like to expand this network by encouraging states that have filed suits to offer advice to states with potential lawsuits.

Technology makes it easy

The lifeblood of all these networks has been computer technology--mainly e-mails and listservs, which automatically transmit messages to network members. "The listserv is the most valuable networking tool we have," says Mary Jo Atherton, executive director of the Wyoming Psychological Association and chair of the Council of Executives of State and Provincial Psychological Associations (CESPPA), a professional organization for the executive directors of state and provincial psychological associations.

Listservs and e-mail allow states to share information about legislation and managed-care issues, says Sheila Schuster, PhD, CESPPA's chair-elect and executive director for the Kentucky Psychological Association.

Similarly, legal network members often share drafts of letters they have written to their members asking for contributions or more information to bolster their lawsuits, says Michael Haley, PhD, executive director of the California Psychological Association.

The listservs are also used to encourage members to contact their state or federal representatives. E-mail makes it easier to send people detailed information about an issue, why they should support it, and who to call, says David Proefrock, PhD, federal advocacy coordinator for the Georgia Psychological Association.

"You can do in minutes what used to take hours of contacting people by telephone," says Sarah Brennan, PhD, federal advocacy coordinator for the New Mexico Psychological Association.

Nothing replaces personal contact

But, e-mails cannot replace personal relationships that allow for one-on-one discussions of issues and concerns. Members say personal contacts and face-to-face meetings remain essential to successful and effective networking.

"Legislative networks work better if they are based on personal relationships," says Proefrock. "We spend most of our time identifying people who have a connection with a legislator. Either they live next door to the legislator, or they went to college with the legislator, or their kids play ball together."

Personal connections also benefit the public education network and can lead to opportunities for public education events. "We train people to think of the contacts they already have through community groups, the church they attend, the school they went to and the school their children go to," says Nancy Molitor, PhD, public education campaign coordinator in Illinois.

Similarly, personal relationships help the Business of Practice Network members to get a foot in the door to meet with human resources directors, chief executive officers or chief financial officers about the affordability of comprehensive mental health benefits, says Robert Doyle, PhD, a business network member in Arkansas.

One way to build personal relationships is to network outside of APA. Schuster, of Kentucky, for instance, helped organize several statewide networks and coalitions including Kentuckians for Health Care Reform and the Kentucky Mental Health Coalition. By participating in these groups, Schuster says she can educate others about psychology's role in health-care reform.



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