Fast-track prescription policy is no ?end-run?

Russ Newman, PhD, JD
APA Executive Director for Practice

As interest, energy and activity related to the prescription-privileges agenda increase, the amount of dialogue, debate and information has expanded as well. Generally, this increased information has helped clarify significant issues related to prescriptive authority. Periodically, however, inaccurate information finds its way into the 'marketplace of ideas' and exacerbates existing tensions and disagreements. One such piece of information is an article in the July/August issue of the National Psychologist, '1996 council vote was end-run maneuver.' In this account of the APA Council of Representatives? legislative approval of the prescription privileges agenda, Henry Saeman, editor of the publication, remarks, 'the hasty approval of prescription privileges (by the Council) did lack the deeper look at the issues that APA generally requires, and may have helped generate a number of frustrated psychologists who are now voicing their opposition to prescription privileges in state legislatures, an effort orchestrated by AAAPP.' This statement appears based on the perception that the 1996 prescription privileges endorsement did not receive standard APA governance review and, therefore, precluded relevant boards and committees from having an opportunity to formally consider the issue.

In fact, the APA Council took two actions related to prescription privileges during 1996, one in February and another in August. Neither would be aptly characterized as a rush to judgment if all the facts and the complete legislative history were considered.

At its August 1995 meeting, Council reaffirmed its 1986 policy that psychology practice encompasses both physical and psychological interventions. The Council expanded on this principle to say, 'specifically, this current action contemplates and supports Association activities in seeking prescriptive privileges for psychologists. Such activities may include, but are not limited to, support and assistance for the development of appropriate training curricula and training programs, and support and assistance for legislative advocacy.' The resolution further directed the development of a proposed model training curriculum and model legislation for prescriptive authority.

Then-President Robert Resnick responded to this Council action by appointing a work group chaired by Past-president Ron Fox and composed of two members each from the Committee for the Advancement of Professional Practice (CAPP), the Board of Educational Affairs and the Board of Scientific Affairs. The interdirectorate group worked to develop two specific proposals: 'Model Legislation for Prescriptive Authority' and 'Recommended Postdoctoral Training in Psychopharmacology for Prescription Privileges.' These two documents included the APA?s proposed policy positions for training and credentialing to prescribe medication. In pursuing its charge, the work group built on groundwork laid by a Board of Directors ad hoc task force and a CAPP task force that previously had explored related training and legislative advocacy issues.

The work group?s two proposals were presented to the Board of Directors and Council at their respective February 1996 meetings. The APA Council, on the Board?s recommendation, approved the two proposals as interim documents so that they could be referred for review by the association?s boards and committees at the spring consolidated meetings. The work group made revisions to the interim documents based on the results of the consolidated meeting reviews. Also importantly, the two proposals submitted to Council for final approval reflected the comments of state psychological associations and relevant divisions. Council adopted both documents as APA policy in August 1996.

These policies now provide the basis for the association?s work in the prescription privileges area. Although fast-track by APA governance standards, the process to arrive at these prescription privileges policies was hardly an ?end-run.? The legislative process made use of existing review mechanisms, including the association?s consolidated meeting structure. Furthermore, the work group established to draft the proposed model curriculum and model law was constituted expressly to represent the perspectives of the practice, science and education communities.

The actual agenda item provided to Council in August 1996 included the following statement from the diverse work group: '?a great deal of thought and attention to detail went into the drafting of the documents. This thought and detail are related to the issues and concerns of the broad APA constituencies and the documents have been crafted to ensure the strongest possible support from all quarters of the Association.'

Unquestionably, not all APA members agree with the association?s decision to pursue prescriptive authority. Continuing discussion will and must occur to deal with remaining issues, concerns and legitimate anxieties about our profession?s movement into this new area. It is clear, however, from the legislative process related to Council?s adopting a policy supporting prescription privileges that, rather than making an end-run, proponents of this policy ran it right down the middle of the field.