2007 Annual Reports for Boards and Committees
Committee for the Advancement of Professional Practice
The Committee for the Advancement of Professional Practice (CAPP) serves a dual role, having governance responsibilities in both the 501(c)(6) APA Practice Organization (APAPO) and the 501(c)(3) American Psychological Association. In serving as the administrative agent of the APA and APAPO Board of Directors, CAPP has responsibility to exercise general governance supervision in the management of the 501(c)(6) companion organization, and over the relevant affairs of the Practice Directorate. This report will briefly summarize both aspects of CAPP’s activities during 2007.
According to Association Rule 90-2.1, CAPP consists of nine regular members who shall be psychologists who provide health care services, who are licensed to practice psychology in at least one state, district, or province, and who pay the annual assessment, and two special members, who need not be psychologists, chosen for their expertise. The 2007 members of CAPP were: Katherine Nordal, PhD (Chair); Nanci Klein, PhD (Vice-Chair); Glenn Ally, PhD; Nancy Gordon Moore, PhD; J. Paul Burney, PhD; Bobbie Celeste, PhD; Rosalind Dorlen, PsyD; Josephine Johnson, PhD; Sanford Portnoy, PhD; Michael Ranney, MPA; Bill Safarjan, PhD; Carol Goodheart, EdD, served in an ex-officio capacity as APA Treasurer; and Lisa Grossman, JD, PhD served as the APA Board of Directors liaison.
In carrying out its dual missions for the APAPO and for the APA, CAPP has developed and reaffirmed several overarching priorities. The APAPO priorities are in the service of promoting the mutual professional interests of practicing psychologists in all settings through a wide range of advocacy activities focusing on policymakers, legislatures, the legal system, purchasers and consumers of services, and the overall healthcare marketplace. The APA Practice Directorate priorities serve to enhance human welfare through the professional practice of psychology. CAPP priorities include:
Maintaining and pursuing a strong advocacy agenda
Generating additional resources for practitioners and the profession
“Re-branding psychology” as a major helping profession
Expanding the applications of psychology
Building a professional network of key alliances and connections
Integrating the practice community
Educating the public about the value of psychology
Providing outreach and support in the aftermath of disasters
Supporting workplace practices that enhance employee health and well-being
Helping psychologists meet consumers’ needs for mental health services
In the Articles of Incorporation for the APAPO, CAPP is charged with the responsibility “to identify, plan and implement projects important to the protection, defense, and enhancement of professional practice and recommend to the Board of Directors the needed funding for such projects". As a separately incorporated (c)(6) organization, the Practice Organization is able to engage in advocacy on behalf of the profession free of the IRS provisions that constrain advocacy by a (c)(3) organization.
(c)(6) Programs and Activities
Several major program areas and activities of the APAPO carry out CAPP’s (c)(6) mission and priorities on behalf of practicing psychologists. During 2007, these included a number of major components of CAPP’s advocacy agenda, as well as undertakings designed to generate additional resources for the purposes of providing increased advocacy and additional services to practice assessment payers.
CAPP oversaw the continued enhancement of its primary communications vehicle and information technology infrastructure, the practitioner portal, APApractice.org, which continues to support the practice community with easily accessible practical resources.
The Practice Organization continues monthly publication of PracticeUpdate, a member newsletter. PracticeUpdate, which provides timely and practical practice management information, is sent via email to APA members who pay the Practice Assessment and practice-oriented APAGS members and is also available online at APAPractice.org.
CAPP has continued to support the APAPO’s top legislative advocacy priorities. On the federal legislative front, psychology advocates continue to work on prescriptive authority privileges, mental health parity, Medicare reimbursement issues and a number of other causes that support practicing psychologists.
The APAPO and CAPP continue to help a number of states work toward achieving and implementing legislation that gives qualified licensed psychologists the authority to prescribe psychotropic medications. A record nine states introduced RxP legislation in 2007. Organized psychology in Hawaii made its furthest progress to date in longstanding efforts to achieve prescriptive authority for licensed psychologists. The Hawaii legislature passed and sent an RxP bill to Gov. Linda Lingle early in May. The governor chose to align herself politically with organized medicine in vetoing the bill, and the legislature was unable to garner the votes needed to defeat the governor’s veto.
At least 22 state, provincial and territorial psychological associations now have active tasks forces and committees to seek RxP legislation. Support from the national level for state psychological associations includes CAPP grants and close consultation with state psychology leaders.
Another of CAPP and APAPO’s top legislative priorities involves gaining a broad-based federal mental health parity bill that would close loopholes in current law. The U.S. Senate passed the Mental Health Parity Act of 2007 (S. 558) by unanimous consent on September 18. The Senate bill would require group health insurance plans that offer mental health coverage to apply financial requirements to mental health benefits that are no more restrictive than the requirements pertaining to medical benefits. S. 558 would pertain to all aspects of health insurance plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums.
The Mental Health Parity Act passed by the Senate resulted from months of compromise with representatives of the employer and insurance industries, traditional opponents of full parity legislation. Staff for the APAPO played a critical role in negotiating and drafting legislative language. The APA Practice Organization will actively pursue passage of a strong full parity bill as the House of Representatives takes up parity legislation in 2008.
In addition to cultivating opportunities for the profession, CAPP and the Practice Organization continue to join forces with practitioners and other psychology advocates to confront challenges and obstacles facing the profession. For example, confronting problems with Medicare remains a high priority for CAPP and the APAPO with the goal of ensuring that the program commits sufficient resources to psychological services for beneficiaries.
The APA Practice Organization continues to challenge the 9 percent reduction in Medicare payment for mental health services that took effect in January 2007. The Centers for Medicare and Medicaid Services (CMS) finalized the cut in November 2006 to offset an increase in dollars that the federal agency committed to support evaluation and management (E & M) services. These services involve such functions as establishing diagnosis and treatment options and providing consultation services. Even though we have argued that psychologists are well qualified to provide an array of E & M services, CMS does not allow most non-physicians, including psychologists, to use the codes for these services.
We continue working actively to press both Congress and CMS to negate the 2007 cut in Medicare mental health services and to make psychologists eligible to use the E & M codes. Our efforts on Capitol Hill focus on finding an appropriate legislative vehicle for achieving these goals. More than 300 psychology leaders advocated for changes in Medicare payment when they met with their Senators and Representatives during the APA Practice Organization’s March 2007 State Leadership Conference.
In December 2007, the APA Practice Organization, along with other health professional organizations, successfully lobbied Congress to delay a 10.1 percent across-the-board cut in Medicare reimbursement scheduled to take effect on January 1, 2008. The legislative action delays the new Medicare payment cut for six months. However, because of earlier developments related to Medicare reimbursement, payments for many psychological services provided to Medicare beneficiaries are lower for 2008 compared to 2007.
CAPP continued to provide resources to implement the legal and regulatory strategies that have been put in place by the Practice Organization to influence the changing health care system.
Since its inception, the APA Practice Organization has developed informational materials and products available online to help practitioners understand and comply with the rules resulting from the Health Insurance Portability and Accountability Act (HIPAA).
The APAPO has devoted considerable time and attention to helping members take the necessary steps to obtain and use their National Provider Identifier (NPI) as required by HIPAA. The deadline established in the HIPAA rules for obtaining an NPI was May 23, 2007. Key activities to assist members included: providing comprehensive material about obtaining and using an NPI; sharing information and featuring recent developments concerning the NPI in PracticeUpdate as well as in the Monitor; sending a postcard to our constituents reminding them of the May 23 deadline and guiding them to the website for helpful information; and assisting hundreds of members by phone and email with their related questions and concerns.
In addition, we recently succeeded in having an APA member designated to participate on a subcommittee of the National Uniform Claim Committee, the organization that manages the “taxonomy code” list associated with the NPI. In applying for their NPI, practitioners must select one or more taxonomy codes to describe their practice and the professional services they provide. As a result of APAPO advocacy throughout the past year, psychology gained necessary changes to the list pertaining to psychology that took effect on April 1, 2007.
In the Association Rules, CAPP is charged with the responsibility to: (a) be the administrative agent of the Board of Directors exercising general governance supervision over the relevant affairs of the Practice Directorate, (b) recommend to Council through the Board of Directors procedures for the enhancement of human welfare through the professional practice of psychology, (c) identify projects important to the enhancement of human welfare through the professional practice of psychology, and (d) recommend to the Board of Directors the needed funding for such projects.
(c)(3) Programs and Activities
Several major program areas and activities of the APA Practice Directorate carry out CAPP’s (c)(3) mission and priorities as articulated above. During 2007, these included a number of major programs benefiting the public through the professional practice of psychology.
CAPP oversaw the Practice Directorate’s activities with the APA Disaster Response Network and continues to help stimulate community-based education and outreach efforts through the ongoing APA Public Education Campaign about the value of psychology and psychological services.
APA’s “Mind/Body Health: For a Healthy Mind and Body . . . Talk to a Psychologist” public education campaign initiative highlights psychology’s unique role at the intersection between the psychological and the physical. The Mind/Body Health Campaign educates the public about the connection between psychological and physical health and the role that lifestyle and behaviors play in mind/body health. The Practice Directorate unveiled the APA Mind/Body Health Toolkit to members at the August 2007 APA Convention. The toolkit is designed to support psychologists’ community outreach presentations, media interviews and other local activities that address mind/body health issues. APA members can request a free toolkit by emailing.
The APA’s annual “Stress in America” survey of attitudes and perceptions of stress among the general public garnered considerable national attention. For example, The New York Times, USA Today, Boston Herald and the Chicago Sun-Times were among the major newspapers that carried results of the summer 2007 survey. More than 26 million viewers watched coverage of the survey on 295 shows, including the Today Show. The annual survey by APA seeks to educate the public about the connection between psychological and physical health and to promote the work of psychologists in improving overall health.
In connection with the “Stress in America” survey, the Practice Directorate compiled and made available a “Stress Tip Sheet” for consumers. The material was posted online at the APA Help Center, the Web site for consumers associated with the APA Public Education Campaign. Also as related to the APA Help Center, in August 2007, the Practice Directorate launched a new online ordering system so that APA members can now order Help Center materials online.
Public Relations staff for the Practice Directorate successfully identified news hooks to generate additional news coverage related to stress. These included Labor Day media stories on work stress, pieces on the stress of shopping during the holidays and a radio piece on making New Year’s resolutions, which was heard by more than 13.5 million listeners.
To help serve America’s growing Hispanic population and their need for health education materials, APA launched a new Spanish-language website in the spring of 2007. The site mirrors the content found online at the APA Help Center. The consumer-oriented Help Center and the Spanish-language site offer user-friendly information about a variety of psychological health issues pertaining to work, family, relationships, schools and disasters.
In addition to the public education campaign, APA’s Disaster Response Network (DRN) continues to provide a major vehicle for community outreach and support by member psychologists. The DRN is a national network of psychologists with training in disaster response who offer volunteer assistance to relief workers and survivors in the aftermath of disasters. Since the launch of the DRN in 1992, more than 2,000 psychologists have volunteered their time and professional skills to individuals, families and communities.
As people learned of the shootings on Monday, April 16 at Virginia Polytechnic University, the Practice Directorate mobilized quickly to provide information for individuals in distress. Shortly after the campus rampage, the directorate posted, “Tips for College and University Students: Managing Your Distress in the Aftermath of the Virginia Tech Shootings” on the APA Help Center homepage. The guide offered pointers for strengthening resilience in the aftermath of the school violence. Another resource, “Tips for Parents of School Age Children: Helping Your Children Manage Distress in the Aftermath of the Virginia Tech Shooting,” was also made available at the APA Help Center. The Virginia Tech Counseling Center placed a link to the APA “tips for students” guide on its website homepage. Along with an APA fact sheet on managing traumatic stress, the tips were also among the resources featured at the mental health Web site for MTV University.
The day of the shootings, the American Red Cross sent its Critical Response Team, including APA DRN member Susan Silk, PhD, to Virginia Tech to aid the efforts of the Red Cross Montgomery-Floyd chapter in Blacksburg. More than 50 individuals specializing in disaster mental health, including psychologists, volunteered to assist local relief efforts. Between October and December 2007, psychologists also assisted on the scene of flooding in the Northwest, wildfires in California, ice storms in the Midwest and a mall shooting in Nebraska.
APA’s DRN Advisory Committee co-sponsored a symposium at the APA 2007 Annual Convention with Div. 31 (State, Provincial and Territorial Psychological Association Affairs) to further educate psychologists on ways to better serve minorities in the aftermath of disaster.
CAPP also continued to support the Directorate’s outreach activities to help the business community appreciate the value of psychology in promoting employee health and well-being. One such initiative involves working with the Directorate’s Business of Practice Network to assist state, provincial and territorial psychological associations (SPTAs) with developing Psychologically Healthy Workplace Awards programs. During the March 2008 State Leadership Conference (SLC), the Practice Directorate will present its third annual Psychologically Healthy Workplace Awards (PHWA). Five companies will receive awards for using a diverse array of workplace practices that enhance employee health and well-being, as well as organizational performance. Also during the upcoming SLC, nine companies will receive APA’s fifth annual Best Practice Honors, which recognize companies for a particularly innovative or creative program or policy.
Presentation of the National Awards reflects several years of PHWA program development at the state level, where more than 350 companies have been recognized. Fifty-one state, provincial and territorial psychological associations now participate in the PHWA initiative. Additional details about these awards are available online. Among the new resources available for employers and psychologists who work with them are the Good Company e-newsletter, a searchable database of research abstracts, and the new Good Company podcast and blog that launched in January 2008.
Another current activity illustrates the way in which the Practice Directorate and CAPP are working to meet the needs of children and families. For three years, the Practice Directorate has operated a Parenting Coordinator Program with Family Court of the DC Superior Court. This program provides pro bono parenting coordination services to low-income families involved in child custody disputes, while providing training for closely supervised advanced psychology students at Argosy University. To formalize the Practice Directorate’s relationship with the court and expand this program to serve more families, the Practice Directorate is exploring the development of a memorandum of understanding with the Court while pursuing grants from various charitable foundations.
The Practice Directorate has also completed the first year of its parenting education program with the same court, with very positive reviews from participating families and representatives of the court. Through this program, parents and children attend a parent education class when entering the court system with a custody dispute. The class focuses on reducing conflict between parents and improving communication for the benefit of the children. If the parents are not able to resolve their issues in a subsequent mediation and their case continues, it may be selected for more intense involvement with the Parenting Coordination Program. If so, a parenting coordinator continues to work with the family on conflict and communication issues.
CAPP oversaw many other activities in 2007, including the CAPP Task Force on Serious Mental Illness and Serious Emotional Disturbance (TFSMI/SED), whose focus is evaluating policy issues and supporting the unique contributions of psychologists working with these populations. TFSMI/SED members continued to support APA’s priorities for the implementation of the President’s New Freedom Commission on Mental Health Report and to support projects related to system reform and best practices for clinicians who treat patients with serious mental illness. This Task Force has developed a training grid, which outlines best practices for recovery and improved outcomes for people with SMI. The grid, which showcases a variety of psychologist-developed assessments and treatments, is an educational tool for psychologists, policy makers, consumers and others. Efforts to disseminate the training grid have included providing it to state mental health commissioners and directors of state hospitals in all states as well as to staff at the Substance Abuse and Mental Health Services Administration. On another front, TFSMI/SED is working to focus greater attention on the role of psychologists in recovery through a series of articles being developed by the task force. The Task Force is also working on a survey of Directors of Clinical Training Programs in order to determine the current status of training relevant to adults with serious mental illness.
The Committee on Rural Health (CRH), which reports to the APA Board of Directors and Council through CAPP, continued to provide CAPP with information on its initiatives to ensure that the behavioral health needs of rural and frontier Americans are met. The Committee held business meetings in March and October and conducted business throughout the year via e-mail. The CRH continues working to develop its Rural Health Coordinator Network. The network currently consists of about 40 state, provincial and territorial representatives who address mental health care access issues for rural populations. The coordinators also help promote the practice of rural psychology by working with primary care and state mental health organizations, and by engaging in legislative advocacy and media relations.
This group also is helping to spread the word about the National Health Service Corps (NHSC) Loan Repayment Program. The CRH is focusing its attention on getting Rural Health Coordinators involved with the NHSC Ambassador Program, which provides training and support for practitioners and educators who are interested in filling vacancies in Health Professional Shortage Areas that participate in the Loan Repayment Program. By involving the Rural Health Coordinator Network in the Ambassador Program, CRH seeks to insure that vacancies for mental health professionals are filled by licensed psychologists.
The CAPP Integration Work Group continued to provide a forum for representatives of APA practice divisions and state psychological associations to dialogue and to work toward integrating the diverse practice agendas.
The APA Performance Improvement Advisory Group was formed in 2006 in response to the rapid growth of PFP and other “quality improvement” programs (QIPs) in the private and public health care sectors and to address concerns about how these programs may affect providers and consumers of psychological services. While PFP and other QIPs have the potential to improve quality of care, some psychologists have raised concerns about potential negative consequences. For example, concerns include confidentiality of the performance and outcome data collected, appropriateness of the indicators used to measure quality, and potential impact on health disparities. The Advisory Group has drafted a report to provide a framework for psychologists to use in evaluating QIPs and to help guide advocacy efforts regarding the design and implementation of QIPs. This report is going through the governance review process with the goal of developing APA policy in this emerging area.
The Physician Quality Reporting Initiative (PQRI) is a QIP which provides a financial incentive for health care professionals to report on select measures when filing claims for Medicare services. Providers earn bonus payments by reporting on the program’s measures, regardless of treatment outcomes. The Centers for Medicare and Medicaid Services (CMS) implemented the PQRI in July 2007. Psychologists were limited in their participation since only one of the 74 measures for the 2007 program related to mental health. The measures for 2007 were required by statute and taken almost exclusively from a previous voluntary reporting demonstration program limited to physicians. The Practice Directorate has sought additional measures to make the program more appropriately inclusive of psychological services. The final rule from CMS for 2008 included three new measures for the 2008 PQRI program developed by a work group of psychologists and social workers. These measures involve reporting on patient co-development of a treatment plan/plan of care, screening for clinical depression and screening for cognitive impairment. Additional measures related to psychological services are being developed for the program in 2009.
The tenth annual Department of Veterans Affairs (VA) Psychology Leadership Conference held in May 2007 drew approximately 120 VA psychologists. With its theme, “Changing Paradigms: Leadership and Clinical Applications,” conference participants discussed ways to continue improving mental health services for veterans amidst changes in health care and technology. The annual conference is co-sponsored by the Practice Directorate, Div. 18 (Psychologists in Public Service) and the Association of VA Psychologist Leaders.
CAPP continues to work to enhance its Diversity Initiatives. CAPP members strive to identify and explore the potential multicultural/diversity impact of their committee work. CAPP members are mindful of the importance of having governance members that reflect the diversity of practitioners and the patients they serve and continue to work to enhance diversity within its own membership and on related task forces and working groups. CAPP has a designated diversity slate and this member functions as liaison to the Committee on Ethnic Minority Affairs (CEMA) and is knowledgeable about related issues. CAPP members engage in multicultural/diversity training opportunities as they relate to their own professional and governance work. CAPP members also work within their constituencies to encourage practitioners to engage in this type of training.
A CAPP member, Dr. Josephine Johnson, is the Chair of the Task Force on Implementation of the Multicultural Guidelines. CAPP supported the Task Force Report, which was reviewed by APA governance groups during 2007 and will be considered by Council in 2008.
During the September 2007 CAPP Retreat meeting, Dr. Sandra Shullman conducted a workshop on “The Business of Diversity.” At its November 2007 meeting, CAPP formed a Work Group on Multicultural Issues, which is currently focused on developing a Diversity Management Business Plan.
CAPP is pleased to continue its sponsorship of the Diversity Initiative of the Committee of State Leaders (CSL). The primary goal of the Diversity Initiative of CSL is to involve more ethnic minority psychologists in membership and leadership positions in the SPTAs through funded participation in the Practice Directorate’s State Leadership Conference. This initiative is jointly funded by CAPP and CEMA, as well as by some SPTAs. The program’s success is reflected in the participation of former Diversity Delegates in governance positions, including several presidencies of state associations.