Testimony of the American Psychological Association
Submitted for the record

House Appropriations Subcommittee on Labor, 
Health and Human Services and Education

Regarding Funding for Fiscal Year 2002

March 29, 2001

Mr. Chairman and members of the Committee, the American Psychological Association (APA) represents 155,000 members and affiliates, and works to advance psychology as a science, a profession, and a means of promoting health and human welfare. APA members are involved in a broad spectrum of programs within the jurisdiction of this Committee—for example, as behavioral scientists whose research is funded by the National Institutes of Health, as university professors whose students depend on federal education aid, or as health service psychologists who provide services in schools or in underserved areas. Within each of these programs and others besides, psychologists are working to make a difference in the lives of health care consumers and within the educational system of this country.

National Institutes of Health (NIH)-- One of the most important things this Committee can do to improve the long-term health of our nation is to continue the path toward doubling the NIH budget. The APA strongly recommends an appropriation of $23.7 billion for FY 02.

Six of the ten leading causes of death in the United States are behaviorally based, including HIV/AIDS, smoking, violence, accidents, poor diet, and substance abuse. Other behavioral factors are known to increase individuals’ risk for disease, disability and early death: obesity, physical inactivity, inadequate social support, exposure to environmental contaminants, anxiety, and traits of anger, hostility or depression. As important as individual behavior is to health, NIH must also continue to examine social factors — racial/ethnic status, gender, age, income, education, cultural orientation, and community—that have important effects on health. Behavioral and social science research at NIH is making important contributions to health in our nation. Examples are:

• The National Institute on Drug Abuse (NIDA) is making state-of-the-art substance abuse treatment regimens available to broader community populations through its expanding Clinical Trials Network. This network makes it possible to test new treatments quickly and thoroughly to see whether they are effective outside laboratory settings. Psychological scientists are involved in developing prevention programs and in developing and testing pharmacological and behavioral treatments for smoking cessation and various drugs of abuse. Largely because of NIDA’s research, we know that drug abuse is a preventable behavior, and that drug addiction is a chronic brain disease that can be treated just as effectively as many other chronic disorders.

• The National Institute of Child Health and Human Development (NICHD) continues to fund research to illuminate how children learn to speak and read. The discovery that children must learn to break words into their component sounds, or phonemes, in order to learn to read, has changed the way many school systems in our nation teach reading, and is a main reason for the return to phonics-based reading instruction. Continued advances in developmental research will be critical to ensure the effectiveness of teaching strategies and classroom interaction. A sustained investment in developmental research at NICHD will result in additional knowledge about the ways in which children learn at key stages of their lives and education.

• Increasing evidence from studies funded by The National Heart Lung and Blood Institute (NHLBI) shows that comprehensive rehabilitation programs that include counseling or stress management training for patients after heart attacks are significantly more effective in preventing subsequent heart attacks than no rehabilitation or less comprehensive programs. Behavioral researchers funded by NHLBI have shown that personality characteristics such as hostility are significantly associated with artery calcification and the development of heart disease.
  

• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed important partnerships with college administrators and student organizations to strengthen its research on college drinking. With sufficient resources, NIAAA would spend additional funds on research to prevent and intervene with alcohol abuse in college settings, and to disrupt drinking patterns that might lead to alcohol dependence after college.
  

• To address the gap between what is known in the world of research and what is applied in clinical care, The National Institute of Mental Health (NIMH) charged the Behavioral Science Workgroup of the National Advisory Mental Health Council to report on potential strategies. The group’s report, Translating Behavioral Science Into Action, focuses on three areas: understanding basic behavioral processes in mental illness; understanding how mental illnesses and their treatments affect the ability of individuals to function in diverse settings and roles; and understanding how social or other environmental contexts influence the development and prevention of mental illness, and the treatment and care of those suffering from mental disorders. NIMH’s action plan to implement the report includes establishing translational behavioral science research as a priority funding area for NIMH.

The NIH Office of Behavioral and Social Sciences Research (OBSSR) exists to help coordinate the behavioral and social science research at NIH, and to enable collaborations on cross-cutting issues that serve the missions of multiple institutes. OBSSR’s budget for FY 01 is $20.6 million. APA supports an appropriation of $23.6 million for OBSSR in FY 02, an increase of 15 percent. Such an increase would allow the Office to implement the recommendations in the National Research Council’s (NRC) new report, New Horizons in Health: An Integrative Approach. The report identifies research priorities that cut across Institute domains, underscoring the broad significance of social and behavioral science research for multiple disease outcomes as well as health promotion. The NRC report recommends ten priority areas for research investment: predisease pathways, positive health, gene expression, personal ties, health communities, inequality, population health, interventions, methodology, and infrastructure.

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Centers for Disease Control and Prevention-- APA supports the Friends of CDC appropriations recommendation of $5 billion for FY 02. This level of support is needed to help translate biomedical and behavioral research into community-based prevention strategies that, in essence, deliver on the promise that research has created.

National Center for Injury Prevention and Control--APA recommends $15 million for the Multi-Site Violence Prevention Evaluation Study to further CDC's efforts to examine the effectiveness of interventions to reduce violence in schools by increasing the number of target schools. An additional $10 million is sought to expand the National Academic Centers of Excellence on Youth Violence initiative. To establish a basis for uniform reporting and accountability for youth violence prevention programs, $20 million is needed to create a National Death Reporting System.

Suicide Prevention-- APA recommends an additional $40 million for suicide prevention programs and for regional resource centers to provide technical assistance to states, schools, community organizations, and the health professions, targeting those populations at significant risk for suicide, i.e., African American males, American Indians and Alaska Natives, adolescents, and the elderly.

Violence against Women and Child Maltreatment-- APA urges the Committee to support a

$5 million increase for CDC's prevention and early intervention programs focused on violence against women, including demonstration projects, program evaluation, and information dissemination. APA also requests a $10 million increase for child maltreatment initiatives to further prevention efforts, state-based surveillance, data gathering, program evaluation, and dissemination of effective interventions.

National Institute for Occupational Safety and Health (NIOSH)--APA urges the Committee to increase NIOSH’s funding by $50 million over FY 2001. The proposed increase would support $25 million for its National Occupational Research Agenda to include an initiative on Health and Safety for an Aging Workforce. This request would also support $10 million for the Education and Research Centers to provide training for professionals in occupational health, and $10 million for NIOSH to develop core-tracking systems for occupational health and safety and to help build a national system for identifying and responding to hazardous exposures and risks in the workplace.

Office of Smoking or Health--The Institute of Medicine recently released, "Clearing the Smoke," a report that will help chart the federal government’s efforts to reduce the harm caused by tobacco use. Among other recommendations, the IoM report calls for long-term epidemiological studies of populations or pilot groups of tobacco users. Most tobacco-related diseases develop clinically over many years, so information provided over time from users as well as non-users, along with biological specimens to be used as biomarkers, could lay the foundation for 21^st Century efforts to reduce tobacco related health impacts. The IoM suggests that this information could potentially be collected as an addition to current longitudinal surveys. APA suggests that CDC be given additional authority and resources to implement that recommendation.

Agency for Healthcare Research and Quality (AHRQ)—APA supports the recommendation of the Friends of AHRQ for FY02: $400 million is needed for the agency to fully implement its mandate to improve health care quality, including reducing errors in medicine. In the current fiscal year, AHRQ will spend $50 million in researching methodologies for documenting and reducing medical errors. With the recommended budget, AHRQ would be able to spend $60 million to fund new investigator-initiated grants. The translation of research into clinical practice is a priority for this agency, and additional resources are needed to speed this work. The Institute of Medicine has found that less than half of Americans are getting high quality care for major health problems, including diabetes, asthma, depression and schizophrenia.

Bureau of Health Professions—APA recommends that the Appropriations Committee provide $6 million in FY 02 for a Graduate Psychology Education (GPE) Program in the Bureau of Health Professions (BHPr) within the Allied Health and Other Disciplines budget authority of the Health Resources and Services Administration (HRSA). The statutory authority exists in The Health Professions Education Partnerships Act of 1998, P.L. 105-392, amended Part D, Sec.755 of the Public Health Service Act. The purpose of the GPE program is to meet demonstrated needs for integrated, interdisciplinary health care services in underserved areas.

Substance Abuse and Mental Health Services Administration (SAMHSA)-- The increasing number of young children diagnosed with mental disorders, the rising teen suicide rate, and the recent incidents of school violence are all indicators that our nation’s children and youth have serious unmet mental health needs. To address these needs, APA recommends that the Committee provide $100 million for the Comprehensive Community Mental Health Services for Children and their Families Program so that it may continue to develop, provide, and evaluate mental health services for children and youth and expand the program into new states and localities.

Safe Schools/Healthy Students initiative-- APA recommends that the Committee provide $250 million as part of the federal response to the crisis of school-based violence. APA applauds the Committee’s foresight in creating this coordinated effort among the Departments of Health and Human Services, Justice, Education, and Labor to develop empirically supported programs to prevent youth violence and to intervene with families, schools, and communities where violence has already occurred.

Administration on Aging—APA urges the Committee to appropriate $2 million to fund a Graduate Geropsychology Training Program (GGTP) as authorized in the Older Americans Act Amendments of 2000, Title IV, Training, Research, Discretionary Projects and Programs Part A Section 411 (1)(8). This program is currently unfunded. Its purpose is to address the shortage of mental and behavioral health professionals who specialize in a range of aging issues, such as suicide, Alzheimer’s disease and safe driving. Geropsychologists and other mental and behavioral health professionals provide much needed services for mental disorders, such as dementia and depression, as well as for the promotion of health and functional competency for successful aging. The mental health field needs federal support to train professionals to provide mental and behavioral health care to the growing population of older persons.

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Psychologists are working hard to improve the learning experience and educational opportunities available to all students in this nation throughout the continuum of learning. Through psychological research, the application of that research and direct services to students, teachers and others, psychologists are at the forefront of educational reform efforts, early childhood education, the development and use of tests in educational and special educational settings, and the provision of mental health services.

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