Public Policy Update

Although the economy remains sluggish and national security is still the top priority, many policy-makers are diligently setting time aside to address the needs of those who are most vulnerable in difficult times--children and older adults. APA's Public Policy Office (PPO) has been working closely in recent months with congressional champions, who, despite it all, remain committed to reaching out to their oldest and youngest constituents by introducing new, exciting legislation.

Addressing the mental health needs of older Americans

The fastest growing population subgroup, older Americans mostly enjoy good mental health, but as many as 20 percent experience some type of mental disorder. Among the mental health concerns affecting our older citizens are access to and cost for high-quality services that address prevalent disorders such as anxiety, depression and cognitive impairment, caregiving issues, and abuse, neglect and exploitation. The following pieces of legislation have recently been introduced in Congress to address some of these pressing issues:

  • The Positive Aging Act (H.R. 2241/S.1456), introduced in the House by Reps. Patrick Kennedy (D-R.I.) and Steny Hoyer (D-Md.), House minority whip, and in the Senate by Sen. John Breaux (D-La.), would provide federal grants to enhance access to vital mental health services for older Americans through mental health outreach to primary-care and community-based settings.

PPO and APA's Office on Aging and Committee on Aging worked closely with Rep. Kennedy's office and the American Association of Geriatric Psychiatry to ensure that the law recognized the role of psychologists in screening and assessment of mental disorders as part of a collaborative care team, in providing treatment in community settings, and in developing intervention and treatment protocols.

Other improvements to the draft legislation included the creation of a targeted spot for a psychologist with aging expertise on the National Advisory Council of the federal Center for Mental Health Services and the incorporation of language that promotes a positive image of older adults and aims to reduce stigma and prejudice. APA continues to work with Rep. Kennedy's office to support the Positive Aging Act through congressional outreach and grassroots advocacy.

  • The Elder Justice Act (S. 333/H.R. 2490) was introduced by Sen. Breaux and Reps. Rahm Emanuel (D-Ill.), Peter King (R-N.Y.) and Roy Blunt (R-Mo.), House majority whip. If enacted, this legislation would ensure attention to elder abuse by improving the quality, quantity and accessibility of information related to elder abuse; increasing research and resources; developing forensic capacity for police and investigators; providing victim assistance and support for at-risk elders; increasing prosecution; funding states' adult protective-services systems; expanding and enhancing training; funding special programs to support such underserved populations as rural and minority seniors; creating model state laws and practices; and establishing an Elder Justice Resource Center and Library.

PPO worked with congressional staff to have a technical amendment attached that will insert psychologists--who had been inadvertently omitted--in the list of health-care professionals eligible for training grants awarded as part of the legislation. PPO continues to support this legislation as a member of the National Elder Justice Coalition, which has more than 155 member organizations.

Making the grade on children's issues

One in 10 U.S. children and adolescents has a mental disorder, while less than half of these children receive treatment. In 2000, then-U.S. Surgeon General David Satcher, MD, reported that "growing numbers of children are suffering needlessly because their emotional, behavioral and developmental needs are not being met by those very institutions which were explicitly created to take care of them." Many members of Congress recognize these unmet needs. PPO has been working with many of them on the following pieces of legislation to promote children's well-being:

  • The Child Health-Care Crisis Relief Act (H.R. 1359/S. 1223) was introduced by Reps. Kennedy and Ileana Ros-Lehtinen (R-Fla.), and Sens. Jeff Bingaman (D-N.M.) and Susan Collins (R-Maine) to increase the number of well-trained mental health professionals providing clinical mental health care to children and adolescents, including those based in schools. This legislation would offer scholarships, loan repayment and grants to individuals pursuing careers in children's mental health, enhance training programs through training and institutional grants, and provide funding to community-based providers.

APA's public policy team worked closely with congressional staff in drafting this legislation and is now reaching out to APA members to encourage their involvement in gaining more co-sponsors for it.

  • Legislation to reauthorize the Individuals with Disabilities Education Act (IDEA) (H.R. 1350/S. 1248), which is the federal legislation that upholds the right of children with disabilities to a free, appropriate public education in the least restrictive setting and outlines educational requirements for state agencies.

PPO staff participated in a series of meetings with House and Senate staff to develop legislative proposals to improve IDEA. Its staff contributed to provisions in the House bill to enhance prevention and early intervention, demonstration programs, and research and related services-personnel provisions. Meetings with Senate staff focused on the use of functional behavioral assessment, disciplinary procedures and alternative educational placements.

APA's Public Policy Office will continue to support enactment of effective reauthorization legislation, while warding off efforts to unduly restrict accessibility to special education services by limiting eligibility criteria and the range of qualified providers.

  • The Family Opportunity Act, also known as the Dylan Lee James Act (S. 622/H.R. 1811), was introduced by Sens. Charles Grassley (R-Iowa) and Edward Kennedy (D-Mass.), and Reps. Pete Sessions (R-Texas) and Henry Waxman (D-Calif.) to allow middle-income families of children with disabilities to buy into the Medicaid program to obtain health and mental health services.

PPO staff, in coalition with the Consortium for Citizens with Disabilities (CCD), continue to conduct congressional visits and send letters to urge key members of Congress to support this vital piece of legislation.

  • The School Readiness Act of 2003 (H.R. 2210), a bill to reauthorize the Head Start program, was approved by the House Committee on Education and the Workforce on June 19. It would increase the program's focus on early literacy skills over other service components (health, social services and parent support, for example) and establish a block grant program in eight states. (See the July/August Monitor for news of PPO efforts to inform Congress about relevant psychological research.)

Caring for caregivers

According to the National Family Caregivers Association, 59 percent of the adult population is or will be a caregiver for a chronically ill, disabled or aged family member or friend. Although caregiving can be very rewarding, loved ones who take on this role face many challenges, including financial, emotional and time-management stressors. The following legislation recognizes the important contributions of caregivers by addressing their need for high-quality respite care:

  • The Lifespan Respite Care Act of 2003 (S. 538/H.R. 1083) was introduced by Sens. Hillary Clinton (D-N.Y.) and John Warner (R-Va.), and by Reps. James Langevin (D-R.I.) and James Greenwood (R-Pa.), and members of the House Disability Caucus. This legislation would authorize $90 million in competitive grants to states and other eligible entities to make respite care available to family caregivers, regardless of age or disability, and would help support planned and emergency respite care, respite-worker training and program evaluation.

APA policy staff continue to work with the National Lifespan Respite Care Task Force and CCD in support of this legislation. Specifically, APA has joined coalition members in visits to congressional offices and in planning a congressional briefing on psychological research on the benefits of respite services for caregivers and care recipients--as well as the cost-savings to states.

Get involved

PPO's work is bolstered by APA members who share their research, clinical experience and overall expertise related to social issues of national importance. We invite you to work with us and to learn more about becoming involved in PPO advocacy efforts by visiting our Web site

Diane L. Elmore, PhD, is the SPSSI James Marshall Public Policy Scholar in APA's Public Policy Office and can be contacted at delmore@apa.org.