Town hall meeting focuses on gaining prescription privileges

By Kathryn Foxhall
Monitor staff

How do American psychologists win prescription privileges?

Slowly, patiently, one state at a time.

That's some of the advice that was stressed at the Town Hall Meeting on Prescription Privileges at APA's 1999 Annual Convention, Aug. 20 - 24 in Boston. The Aug. 22 session brought together, in speakers and audience, many of the state and national leaders who are driving the prescription privileges movement.

Although no state currently grants psychologists prescription privileges, several states expect their legislatures to approve the measure in the next few years. Last year the Territory of Guam became the first U.S. jurisdiction to pass such a bill.

George P. Taylor, PhD, a member of APA's Board of Directors, has worked on the process in Georgia, a leader on the issue. He told representatives from other states: "To plan to do something in too short a period is not wise, so it makes sense to lay out a plan that covers a number of years."

Stephen G. Rudin, EdD, who has worked with several state committees on prescribing privileges, agreed. Some states are starting from zero, with no bills before the legislature, he said, and building political momentum takes a number of involved steps.

Rudin, a private practitioner and director of pharmacology at Bridgewater State College, participated in the forum for Sam Feldman of the Prescribing Psychologists Register, because Feldman was forced to cancel. Rudin advised advocates to first "identify the groups or the entities whose goal it is to achieve prescription privileges." This includes state psychology associations, the schools of professional psychology and all types of programs with psychopharmacology training, he said.

After that, he said, form an advocacy group by pinpointing people who are truly representative of those entities and who also have strong leadership capabilities.

Similarly, Taylor said, the person spearheading the push should be "tough-thinking, quality-oriented" as well as effective and persistent.

Interestingly, said Rudin, state groups seem most effective if they take a name that's not linked to any of their individual local entities. As an example he suggested "The (name of state) Committee (or Caucus) for Psychologist Prescribing Privileges."

He cautioned state groups that getting a bill introduced is less of a problem than gathering sponsorship and support for it. Take a cue from states that have moved the legislation closer to passage, said Rudin: No state has been particularly effective with fewer than three lobbyists.

Who pays for such advocacy? Rudin suggested that state groups solicit funding with mass mailings to psychologists who have expressed an interest in getting the legislation passed, and even apply for grants where available.

In addition to working with state legislatures, Ruth U. Paige, PhD, of Seattle, said a next critical step is intense work "to get huge numbers of current and all future psychologists trained at least to a minimum level in basic pharmacology."

Paige, also a member of APA's Board of Directors, contended that psychologists need to reframe their argument before state licensing boards, defining it as an issue of competence, rather than simply a matter of psychologists wanting the privilege. Various studies, she noted, find that 30 percent to 68 percent of patients coming into psychologists' offices use medications. Psychologists need to be able to deal with issues relating to those prescriptions, she indicates.

Charles A. Faltz, PhD, director of professional affairs at the California Psychological Association, agreed that the focus of the debate should change. He suggested that psychologists point out in the legislatures, for example, that there are often not enough psychiatrists on call to fill the need.

Paige suggested that licensing boards mandate that students at the predoctoral level be required to log 50 hours of "clock" time in psychopharmacology--the equivalent of about one three-hour academic course. At the same time, she said, advocates should urge universities to offer that same level of training in every psychology doctoral program.

"I think for us not to be trained in at least the basic psychopharmacology," she said, "is unethical practice."

What about the psychologist who has been in practice for decades and does not want to go back to school for this, the panel was asked?

"We are saying that there is lots of room for diversity within our profession," said Debra L. Dunivin, PhD, of the Eisenhower Army Medical Center in Augusta, Ga., who chaired the session.

Others on the panel said some psychologists may want to go into prescribing and others may not, but they can all work together for the welfare of their patients.

Despite the work left to do, APA President-elect Pat DeLeon, PhD, JD, said, "I'm really pleased at the extent to which the prescribing authority evolution has become, now, really, mainstream," among psychologists. He noted that when APA's Board of Directors was asked to designate contingency funds for supporting such initiatives at the state level, the overwhelming response was "that makes sense" and "let's do it."Y



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