Preparing for the future: practitioners seek training for prescribing medication

Some psychologists are preparing for the day when they expect to have the legal right to prescribe medications.

By Rebecca A. Clay

For some state psychological associations, getting psychologists trained is a key part of the strategy for pushing for the right to prescribe. Whether they?re seeking training before introducing a prescriptive auth-ority bill or tackling both challenges concurrently, these associations believe that developing a cadre of trained psychologists demonstrates their seriousness and boosts their credibility with state legislators.

Although no state has yet passed a bill to authorize prescription privileges for psychologists, a handful of states introduced prescription-privileges legislation this year. And as the fight intensifies, psychologists all over the country are using a variety of strategies to get the training they?ll need.

Some psychologists are putting together university-based programs. Others are turning to the courses offered by the for-profit company Prescribing Psychologists? Register® Inc. (PPR). At least one is undergoing training in a nurse-practitioner program.

Psychologists should keep several things in mind as they explore their training options, advises Elizabeth A. Cullen, JD, former director of APA?s office of managed care and now APA?s director of congressional affairs. They should look at whether a program is truly based on APA?s model curriculum, paying special attention to how and where the clinical training component will be offered. (See sidebar.) They should also be concerned about whether the training program is rigorous enough to convince legislators, physicians and others that the program?s graduates will have the training they need to prescribe safely, Cullen says.

University-based programs

The Louisiana Psychological Association (LPA) has launched the kind of training program state legislators might look favorably upon, predicts Cullen, adding that the Georgia Psychological Association and the Hawaii Psychological Association have put together similar programs. Last year Louisiana became the first state to see a prescription-privileges bill make it out of the committee and onto the floor of the state legislature.

When LPA decided to offer training to its members, it approached various universities in the state. But the universities rejected the association?s overtures, says John F. Bolter, PhD, chair of LPA?s psychopharmacology committee and director of neuropsychology at the Neuro-medical Center in Baton Rouge.

Because opposition from the psychiatric community has made the issue of prescriptive privileges politically charged, he says, the universities didn?t want to imply they were endorsing prescription privileges for psychologists.

LPA then thought about offering the training as continuing education, but abandoned the idea for fear that it would appear too self-serving. The association also rejected contracting with PPR to provide the training.

In the end, LPA decided to put together a program drawing on the Department of Defense (DoD) Psychopharmacology Demonstration Project model that forms the basis of APA?s own model curriculum. The DoD model offers a systematic, thorough grounding in anatomy, physiology and other basics before it even broaches the subject of pharmacology, Bolter says.

'Learning what medicine to give for a specific mental disorder is less difficult than acquiring the knowledge to appreciate the medical risk accompanying the prescription,' says Bolter. 'Our program is really about acquiring the knowledge necessary to make informed and safe prescription-writing decisions.'

Working with the DoD model and the APA curriculum, Bolter and his committee tracked down local professors of anatomy, physiology and other subjects who were willing to teach the courses. And they affiliated themselves with the California School of Professional Psychology (CSPP), which agreed to oversee the program. Using the LPA experience as a pilot, CSPP hopes to eventually offer the program to other state associations and on-site at its Alameda campus in California.

Bolter and 34 other practicing psychologists have already begun the every-other-weekend program. Over the next 18 months or so, they will spend more than 400 hours in the classroom immersed in anatomy, physiology, pathology, neuroscience, biochemistry, clinical medicine, health assessment, pharmacology and psychopharmacology. The students will then participate in a clinical internship. Bolter predicts that CSPP will soon approve a plan to grant graduates a postdoctoral master?s degree in psychopharmacology.

'Participating in the training is difficult, because it?s stacked on top of a full-time practice,' says Bolter. 'But I love it. And the class will become very important in terms of our political capacity. We?re already incorporating the program participants into our political activities.'

A ready-made option

For the Oklahoma Psychological Association (OPA), the prospect of developing a program of its own was too daunting. Determined to get started on training before launching a legislative push, the association chose the PPR option.

'Some of the other state associations have been working tremendously hard to develop programs,' explains Patrick J. Mason, PhD, OPA?s immediate past president. 'We had a difficult time believing that by going that route we could get the same type of immediate payoff we?d get by going with folks who are up and running.'

Although OPA eventually hopes to boost credibility with state legislators by developing a home-grown program, the association is using PPR to give members a way to start training immediately.

The PPR curriculum begins with an independent study course that familiarizes participants with basic psychopharmacological principles and terms via textbook. By January of this year, 47 OPA members were ready for their first live training session with a PPR instructor. By the end of the program, participants will have completed 16 live training sessions that each take 18 hours over a weekend to complete, including an exhaustive open-book exam. (PPR also offers Internet courses through the regionally accredited Fielding Institute.)

Mason estimates the process will take two and a half years.

Mason, who has spent what he describes as 'lots of money' jetting around the country to take the courses PPR offers to individual psychologists, is already on his 13th session. 'When you walk out, you feel you?ve learned a lot,' says Mason, president of Health Psychology Associates, Inc., and director of geropsych-ology at the Oklahoma City Veterans Administration. 'Your head?s just stuffed full.'

After the first seven courses, participants earn diplomate status from the International College of Prescribing Psychologists, PPR?s own credentialing body. PPR?s curriculum also requires a clinical preceptorship. PPR requires enrollees to send in complete documentation of histories, treatment decisions and supervision of each patient treated during the preceptorship. PPR also must approve the student?s selected preceptor, Mason says.

Nursing school

Psychologists who don?t want to wait for legislation to be passed before they start prescribing have another option: becoming a nurse practitioner. In many states, nurse practitioners have independent prescriptive authority.

Michael F. Enright, PhD, a member of APA?s Council of Representatives and a private practitioner in Jackson Hole, Wyo., is taking this route.

Enright shares an office with physicians in an area so rural the U.S. Census Bureau classifies it as 'frontier.' When one of the physicians hired a nurse practitioner, he realized that earning a nurse- practitioner degree himself would help him better serve clients in a community that lacks psychiatrists.

'More and more of the patients I see are taking Prozac and other agents,' he explains. 'It?s incumbent on me to educate myself regarding those agents, especially since most of the people I see were placed on their medication by primary-care physicians.'

Enright began working toward the undergraduate nursing degree required for acceptance into a nurse-practitioner program. In 1996, he enrolled in a distance-learning program sponsored by Regents College of Albany, N.Y. Being able to earn a degree without having to leave home was key, says Enright.

For the didactic part of the training, Enright studied the course outlines provided by Regents, read the textbooks recommended and took the exams offered. For the clinical part, he enrolled in a nearby junior college to get the in-state student status he needed to work in a hospital. He then put together an individual study curriculum that covered what he needed to know to pass Regents? clinical performance exam. The director of nursing at the local hospital supervised him during weekly eight-hour shifts.

'Since I was already a member of the hospital?s medical staff, it was a bit of a role change to be there as a nursing student,' says Enright. 'The nurses got such a kick out of it that they gave me a badge that says, ?Dr. Enright, Student Nurse.?' Enright recently took the national licensing test for nurses, which made him a registered nurse. Eventually, he hopes to enroll in a Vanderbilt University distance-learning program to earn a master?s degree in nursing. The final step will be to apply to the nursing boarrd for the advanced nurse-practitioner credential in psychiatric nursing. Once he achieves that goal, he?ll finally be able to prescribe?not as a psychologist, but as a nurse practitioner.

As these three examples illustrate, psychologists intent on prescribing can take a variety of routes to get the training they need.

'There?s clearly a body of psychopharmacological and medical knowledge that has to be achieved in the course of training, but how psychologists put that training together can be very different,' says Russ Newman, PhD, JD, APA?s executive director for practice. 'Acquiring the requisite medical knowledge base without the limiting ?medical model? value system will enable psychologists to contribute something unique to the field.'

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