I, too, would like to welcome you on behalf of the APA Practice Organization to this year's State Leadership Conference - - Psychology on the Front Line: Strengthening Resilience in our Communities. Without question, we and the entire nation have faced unprecedented challenges over the past year. While not the only challenge we faced, but by far the biggest, the terrorist attacks of September 11th have had a profound effect on us all - - as individuals, as a profession, as a community and as a nation. We have all been touched in some way by these events, some more than others. Some of us have lost colleagues, friends and love ones; all of us have lost an innocence. I do not believe it is a melodramatic exaggeration to say that life in this country will never really be the same again (slide 2). One look at the armed military vehicle with gun sights aimed, 24 hours a day, at the entrance to the highway that runs next to the Pentagon will tell you that.

Far from simply being victims of the attacks, however, Psychology rapidly mobilized to become a valuable part of the response. I am proud to say that our profession has been able to make a significant contribution - - and continues to do so - - in the aftermath of the terrorist attacks. The extent of our profession's contribution was not just the result of being trained to respond to psychological trauma, but also because we have been working together for years now, to build an infrastructure that enables us to reach beyond our offices, beyond the therapy and consulting rooms, and to deliver psychological services out in the communities where it was desperately needed. This is where we will find both the figurative and literal "front line" towards which we must continue to direct our attention and our resources. And, I would add, there are likely to be as many front lines as there are identifiable communities in need of our services. More about this aspect of our work and psychology's response to terrorism later. But first, I want to do what I always do at the start of the Conference, provide you with a recap of a number of significant events that have taken place since last year's Sate Leadership Conference.

In the professional psychology advocacy arena, perhaps there is no better example of an advancing front line than the efforts underway to secure prescriptive authority for psychologists. Last year during this Conference, I announced to you that the New Mexico Psychological Association had just been the first state to have a prescription privileges bill successfully voted out of a full legislative chamber when it passed the New Mexico House. But as we know, the Senate did not take the bill up before its session ended.

(slide 3) This year, I have the great pleasure of announcing what many of you already know, that not only did the New Mexico prescribing bill once again pass the House by a 37-21 vote, it also passed the Senate by a rather overwhelming 29-9 margin. The law currently awaits the Governor's signature - - the very person responsible for the bill even being heard during this special session of the New Mexico legislature. Let's hear a round of applause for the great work of the New Mexico Psychological Association. Special commendation goes to Elaine LeVine, who is actually back home preparing for our last push with the governor, and Mario Marquez for their energy, their leadership, their persistence and, of course, their resilience in this emotional roller coaster-like effort.

On a side note, if you have any doubt about the current state of mind of organized psychiatry as a result of this development, you need only look at the depths to which they have sunk in their effort to derail the legislation. (slide 4) "You wouldn't do it to your dog, so why would you do it to your child?" asks the little ApA in an ad in the Santa Fe newspaper. "Those who care about animals insist that the people who treat them be trained in animal medicine" the ad continues, "(so) why would you trust someone not trained in human medicine to prescribe medicine for you and your family?" Apparently, the New Mexico Legislature knows who to trust. We continue to be confident that the Governor of New Mexico also knows who to trust and will soon sign this bill into law and make New Mexico the first state in the country to authorize psychologists to prescribe.

A number of additional states have gained ground in their prescription privileges legislative effort, including Georgia, Louisiana, Texas, Illinois, Hawaii, Tennessee and, relative new-comer Arizona. The territory of Guam, of course, is working to implement, through regulations, its already enacted prescription privileges statute. (slide 5) By the end of 2001, 31 state psychological associations had an RxP Task Force compared to only 19 in 1998. We look forward to psychology's ever increasing momentum with this agenda, and we especially look forward to the moment when the first state domino falls.

Our efforts in the battle against market driven healthcare and its managed care foot soldiers continued throughout the year. Needless to say, we have been disappointed by the delays in the Virginia Academy of Clinical Psychology lawsuit against Blue Cross/Blue Shield of the National Capital Area. While we expected to have gone to trial by now, delays, not uncommon to the judicial system, have us awaiting a decision in response to a pending summary judgement motion, as well as, awaiting a trial date.

In the meantime, however, the issue of "phantom panels" - - (slide 6) those managed care company networks with many fewer providers than advertised, and the very issue the VACP case is about - - has continued to be a growing concern around the country. In fact, this past year California enacted a law specifically intended to ensure that managed care companies must provide timely and accurate information as to the available professionals on their provider panels. It is likely that when the VACP case goes to trial, it will be the first courtroom challenge to the profit-driven, deceptive MCO practice of creating phantom panels. I want to take this opportunity to, once again, thank those of you who have contributed financially, emotionally and otherwise to the lawsuit. We literally could not be fighting this battle without you.

On the Federal front, patients' rights legislation has moved in fits and starts. You will recall that early last year, the Senate passed legislation containing strong "right to sue" language, in fact it was basically our right to sue language. The House followed with compromise right to sue language. And the bill headed to conference for what was expected to be a very tough fight following Congress' summer recess. But events overtook this process and, as the publication BNA recently reported, "Patients' rights legislation has been gathering dust for months as terrorist attacks shifted Capitol Hill's focus away from domestic policy." The latest word, however, is that discussions are starting up again, outside of the conference committee but at the top none the less. We understand that discussions between President Bush, Senator Kennedy and Congressman Norwood are now underway. Once again, the focus of the discussions is the right to sue language, which in our opinion is the backbone of real reform.

Last month's American Bar Association Journal, in an article entitled "Formidable Friends", captured an interesting perspective on the increasing ability to sue negligent managed care companies and the current concern of the managed care industry. (slide 7) "Once foes, doctors and lawyers, have teamed up to target the nation's largest HMOs," states the article. "The impact is already being felt with big verdicts in favor of injured patients." On a related note, I should also mention that at the state level, West Virginia and New Jersey joined seven other states and passed health plan liability laws to protect patient's rights and to provide an "incentive" for managed care companies to not simply cut treatment corners in their never-ending quest for higher profits.

One of our legislative priorities which did not get pushed aside by a post-9/11 Congress was the Mental Health Equitable Treatment Act, legislation intended to create insurance parity for mental health services and put a stop to a significant form of discrimination against people with mental health disorders. The Act passed the Senate in October by voice vote as an amendment to an education and labor appropriations bill in what was clearly a creative procedural move to keep the effort alive despite Congress' radically altered agenda. Unfortunately, the House did not reach the issue, its appropriations bill went to conference without the parity amendment, and at the eleventh hour in December, the conference committee dropped the language needed to enact full parity and only included language to continue the limited protection offered by the parity law first enacted in 1996. Supporters of parity, however, both inside Congress and out, have vowed to vigorously renew efforts in 2002 to pass a strong parity law. You will hear much more about this issue as you proceed through the weekend in preparation for your Hill visits on Tuesday. (slide 8) And we will hear directly from one of the champions of parity, Senator Pete Domenici, on Monday night. Before moving away from parity, I do want to acknowledge the 5 states that made progress on state-based parity this past year: Rhode Island, Kansas, Illinois, Delaware, and Arizona.

Also in the Federal arena, certain developments at the regulatory level within the last year have the potential to affect practitioners' daily lives more profoundly than anything we have seen by way of regulations in quite some time. I am referring to the Department of Health and Human Services' promulgation of the privacy rule intended to help implement the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, or HIPAA, as it is fondly known. Although the final privacy rule actually went into effect in April of last year, the healthcare community, including psychologists, will have until April 2003 to get in compliance with the rule and its requirements.

Those of you who attended the Practice Directorate's Town Hall meeting in San Francisco about privacy and confidentiality received a preview of the HIPAA privacy rule. All of you will soon be receiving much more information about it. In fact, I would dare say that by this time next year you will know more about the HIPAA privacy rule than you ever really wanted to know. (slide 9) The Practice Organization, in partnership with the APA Insurance Trust, is in the process of developing informational materials and tools that will help practitioners understand HIPAA and its rules and, importantly, help practitioners comply with the new requirements.

But for today, what is most relevant is that the Administrative Simplification provisions of HIPAA and its implementing rules are intended as a major step towards an administratively more efficient healthcare system through the use of information technology. By creating a single uniform electronic claims submission process, acceptable to all third party payers, HIPAA hopes to eliminate considerable redundancy and waste in health care, something I talked about at length in last years' State Leadership Conference opening keynote. But in order for this to actually happen, privacy and security concerns must be paramount. Although not perfect, the HIPAA privacy rule is a solid effort to better protect the privacy of all health information, and it sets an even higher standard of privacy for mental health information related to psychotherapy. Importantly, the rule prohibits managed care companies and insurers from conditioning payment on the disclosure of the patient's psychotherapy records.

But to return to the forest and away from the trees for a moment, some see HIPAA as the critical start down a road of healthcare reform which seeks to replace a fragmented state-by-state approach to regulating health care with a federally-driven, more integrated approach to regulation. Federal mental health parity and the patient's bill of rights are also credited with signaling that the realities of the currently ill-conceived U.S. health insurance marketplace are finally coming into focus. (slide 10) One medical economist, J.D. Kleinke, in his recent book, "Oxymorons: The Myth of a U.S. Health Care System", paints the picture well. He writes:

"Five hard years after the Aetna - U.S. Healthcare merger, conventional wisdom has it that managed care has failed to live up to all but its most brutal promises. Left in the rubble are bewildered consumers, disappointed employers, enraged patients, embittered physicians and a raft of lawsuits - - along with a handful of failed or enfeebled healthcare vendors. What once looked like a permanent reduction in health insurance premiums - - thanks to a onetime round of severe price competition among managed care organizations - - turned out to be an anomaly, a momentary pause in their inevitable rise. And the overwhelming majority of clinical studies have shown that for all their rhetoric about population health, illness prevention and disease management, managed care systems do not improve the overall health status of their members. (slide 11) In the final analysis, most "managed care" was "managed cost" all along - - but it failed to accomplish even that goal, and the U.S. healthcare system is worse off for the experiment."

Once an ardent supporter of a pure free market fix to the ills of the nation's healthcare system, Kleinke now sees the necessity of certain broad regulatory solutions for those things we can no longer expect the marketplace to fix. Not only do I think his new direction makes eminently good sense because it's essentially the same direction I've been advocating since 1995, I also think it makes good sense because it takes into consideration the real complexity of our healthcare system, the complexity of its dysfunction and the realization that there is no singular simple solution to its problems. Says Kleinke, "Every solution an entrepreneur or politician can dream up runs headlong into the utter complexity of the system, the uncanny ability of those working in it to defend their precious turf against the solution, and the constant disconnect between what people in health care say they are going to do and what they actually end up doing".

Accordingly, for healthcare to be characterized by choice, continuity, affordability and quality, massive simplification of the system must be brought about. Such simplification cannot occur, by Kleinke's way of thinking, in health insurance markets broken up by state lines, with regulation for one-third of the market by the federal government through ERISA and two-thirds by the states, nor can it occur by offering customers a seemingly infinite number of plan designs. Legislation is necessary to correct tax-code problems, simplify health insurance regulation and streamline marketplace processes. HIPAA is a start toward this simplification process.

While a more detailed look at the additional steps necessary to continue the simplification process is beyond our focus this afternoon, Kleinke's book does provide a glimpse at the healthcare system anticipated from this type of reform. Some call it a "defined contributions" approach to health care, as I have referred to it on prior occasions; others call it "consumer-driven health care". Whatever the term, the following scenario from Oxymorons will give you the idea.

"It is November 2008, open enrollment season for selecting health insurance coverage. Mary, a single mother of two teenage boys, is sitting at her home computer, selecting her health plan for 2009. Mary works for a small company that used to buy fully insured coverage, subject to state benefits mandates and regulations. Because it did not have the financial wherewithal to self-insure under ERISA, the company nearly stopped providing coverage altogether when premiums soared in the late 1990's. Now Mary's company simply sets aside the money it used to pay for each employee's insurance and lets its employees pick whatever health plan they want.

Mary goes to a commercial Web service, enters her zip code, and a moment later is comparing the prices of three dozen different health plan insurers offering coverage in her town. One is a locally owned HMO, another a locally owned PPO. The rest are national HMOs, PPOs, and other kinds of insurers; their only offices are located in Connecticut, the Midwest and California. One insurer is headquartered in Boston and conducts all its business over the Internet. Three dozen insurers all offer the same benefits package, but for different prices. If Mary chooses a plan that costs more than what her company has set aside, the difference comes out of her paycheck before taxes. If she chooses a plan that costs less, the untaxed balance accumulates in her medical spending account, which she can draw on for medical expenses not covered by the plan.

Mary picks the insurer in the middle of the pricing pack because a friend at church told her that it pays for whatever pediatrician and pediatric specialists its members want for their children. According to information on the independent Website, the plan she picks also does not try to switch any of the drugs that a doctor prescribes. These are important things for Mary because one of her sons has diabetes.

Mary also likes the fact that this insurer spends 96% of her premium dollars on medical care, versus only 93% for the average insurer listed on the Website. The accountants in Mary's company also like this aspect of the health insurer's offering. Back in the 1990's, the two insurers that the company had selected for their employees spent between 76% and 82% of the company's premiums on medical care. Because of the compounding effects of the wide differences in medical loss ratios, Mary's health insurance in 2009, on an inflation-adjusted basis, will cost 28% less than it did ten years earlier.

Mary hits the "submit" button, and a moment later her one-page policy for 2009 - - referencing the standard benefits plan and her monthly premium - - appears on her computer screen".

A simple scenario for certain. Is it fiction? Perhaps. But many believe - - and I am among them that with the right combination of regulatory reform and information technology, the future of healthcare includes a truly informed consumer with real power to make choices and no meddling managed care administrative middle men.

Speaking of information technology, the Practice Organization has continued the development of an enhanced information technology infrastructure (slide 12) that we believe will enable us to provide more effective and more efficient services to the practitioner community, as well as to all of your associations. In particular, we are building an Internet-based practitioner portal where practitioners will be able to come for information relatively customized for their area of practice and their interests. They will be able to connect with other psychologists and communities of similar interest and will be able to find a wide range of practice management tools and practice enhancement materials as well. Should there be any doubt of the necessity of enhanced information technology for us to continue to be effective in the 21st Century, one need only to look at the post-anthrax Congress where the use of e-mail and on-line posts has dramatically accelerated in the wake of anthrax laced snail mail. Every member of Congress is now carrying a Blackberry, a wireless Internet device the size of a PDA that keeps them connected by e-mail 24 hours a day. A more detailed preview of the practitioner portal is scheduled for a Sunday morning plenary session.

A number of other things must also be briefly mentioned before moving back to the theme of the conference. First, we succeeded in persuading the Center for Medicare and Medicaid Services (formerly HCFA) to include psychology post-doctoral programs as eligible for GME funding. And we continue to inch closer to inclusion of internship programs. Next, with the help of the Interdivisional Healthcare Coalition, comprised of the Divisions of Health Psychology, Rehabilitation Psychology, Neuropsychology, Counseling Psychology and Pediatric Psychology, we were able to create new health and behavioral assessment and intervention CPT codes. These Codes, in effect, recognize the utility and value of psychological services delivered to people with physical health problems, rather than assuming, as the traditional reimbursement system has, that psychological services can only be used by people with mental health disorders.

For the fifth year in a row, our nominee - - this year, Dr. Len Haas (slide 13) from Utah - - was selected to participate in the Department of Health and Human services primary health care policy fellowship. This, we believe, is yet another indication of the health system's growing acceptance of psychology as a primary care profession and a comprehensive health profession, a development in keeping with 2001 President Norine Johnson's "Psychology Builds a Healthy World" initiative.

Also in the health arena, the Directorate continues to work in collaboration with the World Health Organization related to the International Classification of Functioning, Disability and Health, known as the ICF (slide 14), a classification system based on an individual's ability to function in the real world rather than a diagnostic labeling of illness, disease and pathology. Psychology is currently taking the lead in the development of a procedural manual which, when completed, will facilitate implementation and use of the ICF, not only by psychology, but by a variety of other health professions as well.

In the public health arena, our Warning Signs of Violence campaign (slide 15) continues to engage teens and adults throughout the country. In 2001, there were an additional 228 Youth Forums and 57 Parent Forums, bringing the total number of Warning Signs forums conducted since the inception of the program to almost 1500, with close to 200,000 people having attended the psychologist-led forums.

And in terms of bringing psychology to the workplace, with the help or your organizations and our Business of Practice Network (slide 16), 27 states, have either already given Psychologically Healthy Workplace Awards or plan to give one in the coming year.

And, of course, there are always a variety of licensure-related issues and activities in the various jurisdictions. Many states continued to stave off challenges to their doctoral level licenses. Professional mobility continues to make slow but steady progress in the states. More dramatic mobility developments have occurred in Canada with the signing of the Mutual Recognition Agreement, thanks to the work of the Council of Provincial Associations of Psychologists, as well as, the Canadian Psychological Association.

Before returning to our theme of strengthening resilience as it relates to the aftermath of 9/11, I want to provide a quick note on the continuing work of the Practice Directorate related to political giving - - activity you'll recall, only made possible by the creation of the 501 (c) (6) non-profit, tax-exempt APA Practice Organization. Those of you who attended last year's State Leadership Conference heard the preliminary results of the research we conducted to better understand the practice community's perceptions and attitudes related to political giving and psychology PACs, such as AAP/PLAN, WPLA and state PACs. What we learned is now being incorporated into the development of a strategic plan for significantly increasing psychology's level of giving, and, importantly, increasing psychology's access and voice in legislative circles. (slide 17) While we learned through our research that many practitioners recognize the necessity of combining political giving with lobbying and grassroots advocacy, far too few among us are actually giving. A comparison of psychology's level of giving to that of even similarly sized health professions finds us lagging behind. We intend, with your help, to change this picture in the coming years.

Much clearly has happened since last year's conference. Yet, most occurrences - - no matter how significant they may be - - have paled by comparison to the events of September 11th. Six months later, our country continues to process these events and experiences. Reflecting back on those events, I would say that we were a country initially not prepared for the terrorist attacks on the World Trade Center and the Pentagon. Here in Washington, information and communication during the attacks, were spotty and sometimes confusing. In addition to the plane crash at the Pentagon, an exploding car bomb at the State Department as well as smoke and fire on the Mall were among the events reported by the news media - - events which turned out not to have occurred at all.

Emergency plans were flawed. Some buildings on Capital Hill reportedly were evacuated, while others were not. And many members of Congress milled around on the lawn next to their buildings when they did leave. All federal government workers in DC were released at the same time, along with employees whose private companies, like APA, take their lead on closures from the federal government. Imagine, if you will, some 400,000 people trying to leave Washington at the same time - - a city that is practically one traffic event away from gridlock during a normal rush hour.

Amid the horrific images most associated with the events of 9/11 - - planes crashing and buildings crumbling - - there is perhaps a lesser known, more light hearted image that will endure for those of us here at APA Central Office. Some of you may know that the APA building has an underground parking lot that exits onto First Street. During the evacuation of Washington, traffic was constant bumper-to-bumper on First Street, making it impossible for cars to leave the APA garage. The line of cars waiting to leave the garage continued to grow, as did the exhaust fumes of the idling engines, with little prospect of anyone being able to leave as no one moving along First Street was willing to provide an opening. That is until one of the Directorate's lawyers assertively took matters into her own hands. Picture, if you will, Shirley Higuchi (who many of you know) in her heels and Max Mara designer suit in the middle of First Street commanding traffic to stop with one hand while officiously waving traffic out of the APA garage with the other. While this image never graced the cover of Time or Newsweek, it is unforgettable for many of us none-the-less.

But perhaps the more relevant lack of preparedness from a psychologist's perspective is the degree to which the country seemed psychologically unprepared for the events of September 11th. Neither the 1993 bombing of the World Trade Center nor the 1995 bombing of the federal building in Oklahoma City, as tragic as each was, can be considered the same type and magnitude of the terrorism with which we were confronted this time. In fact, it seemed that on the morning of September 11th, it was not until the second plane hit the World Trade Center that the prospect of terrorism started to replace in people's minds the perception of just a tragic accident.

While the country may have been psychologically unprepared for what happened, psychology's contribution in the immediate aftermath of September 11th was, or at least should be, a great source of pride for all of us. The APA Disaster Response Network, in collaboration with the American Red Cross, was immediately deployed to the World Trade Center, the Pentagon, and the Pennsylvania crash site, as well as to the Boston, Los Angeles, and Washington-Dulles airports. (slide 18) Sixteen State and Provincial Psychological Associations participated in the response. It just so happened that a conference call of the DRN Advisory Committee was slated for noon on September 11th. As a result of that call, a "marriage" of the DRN and the Practice Directorate's nationwide public education campaign coordinators network was initiated. This enabled a widespread community outreach to provide information to help the general public cope, particularly information for parents on how to respond to questions being asked by their children. In addition, our consumer Help Center on the Web (slide 19) also featured a brochure entitled "Coping with Terrorism", one of the few pieces found anywhere dealing specifically with terrorism as opposed to general trauma or disasters. It was subsequently reprinted, almost in its entirety, in the Washington Post (slide 20).

In addition, we were able to use our recently developed Internet based, real time behavior sampling methodology (slide 21) - - PracticeNet - - to survey hundreds of practitioners and get a better understanding of their experience helping clients and patients cope with the terrorist attacks. And, importantly, with the help of the Board of Professional Affairs Advisory Committee on Colleague Assistance, we developed and disseminated a publication entitled "Tapping your Resilience in the Wake of Terrorism: Pointers for Practitioners".

Psychology continued to contribute beyond the immediate response to the attacks. Besides the initial DRN response, the New York State Psychological Association, the New Jersey Psychological Association, the Connecticut Psychological Association and the Virginia Psychological Association have provided a range of pro bono services to their respective communities. The APA Board of Directors Subcommittee on Psychology's Response to Terrorism, formed a few days after 9/11, has continued to marshal experts and knowledge related to the psychological underpinnings of terrorism. Armed with good information, psychologists have continued to work to help replace prejudice with tolerance, while also being ready and available to treat post-traumatic stress disorder or other mental health problems which we know tend to develop after major disasters. A survey (slide 22) of 1,900 Americans we recently commissioned, along with the Infinite Mind Radio show, found nearly one in four people report feeling more depressed or anxious today than at other times in their lives, 16% of which said their depressed or anxious mood was a direct result of September 11th. In real terms, this translates into about 8 million people with mental health effects of the attacks on New York and Washington. As we might expect, the effects have been particularly significant among those with a history of prior traumatic experiences.

Also from that survey, eighty one percent of respondents agreed that in the aftermath of 9/11, they are trying to look beyond setbacks in their lives and move on. But that process may not be so automatic or easy as one would want. It is here that psychologists can be instrumental in helping people, indeed the entire country, move forward. I began to better understand this as a result of a conversation I had shortly after the attacks with one of my friends and colleagues who works and lives two blocks from the World Trade Center. Dr. Marilyn Puder-York (slide 23), an executive coach on Wall Street, described to me her experience on the way to pick up her daughter at a school near the World Trade Center. She was just a block and a half away from the first tower when it collapsed. She literally feared for her life as the accumulating thick smoke and dust made breathing near impossible. Soon after her physical safety was assured, with help given to her by one of her clients, she began to ask more psychologically pressing questions:

• "This has changed my life," she said, "but I'm not yet sure just how. What am I supposed to learn from this?"
• "How do I grow beyond this?"
• "How do I find meaning in my life after an experience like this?"

No doubt, she was not alone in asking these questions.

To better understand how we psychologists might help with these traditionally existential questions now made pressing by current events, I sought out a part of my own past training as a clinician - - Victor Frankl's "Man's Search for Meaning" (slide 24) - to guide me. The search for the book itself proved surprisingly difficult, as I found that it was six weeks back-ordered on Amazon and gone from the shelves of the first few bookstores I visited.

Eventually, I found a copy and it happened to be one that included a preface from the author himself written in 1992. In the preface, Frankl responded to a question about the best-selling success of his book,

"I do not at all see in the best-seller status of my book an achievement and accomplishment on my part but rather an expression of the misery of our time," said Frankl. "If hundreds of thousands of people reach out for a book whose very title promises to deal with the question of a meaning to life, it must be a question that burns under their fingernails."

Perhaps this insight by Frankl is salient to the current scarcity of his book. More to the point, the section of the book on "logotherapy" - -the term used by Frankl to refer to the interventions related to questions of meaning - - offers some direction to us in our current time. He writes:

"Even the helpless victim of a hopeless situation, facing a fate he cannot change, may rise above himself, may grow beyond himself, and by doing so change himself. He may turn personal tragedy into triumph and turn his predicament into human achievement."

Here, I believe, can be found the basis of an important role for psychologists following this horrible tragedy. We must act as guides for the psychological journey of individuals, and indeed of our nation, to find meaning in these events. We must use our knowledge, our research and our clinical skill to help turn personal tragedy into triumph and to help turn our predicament into human achievement, as Victor Frankl would say. The real question, of course, is how do we best accomplish this. Perhaps our data as to the public's current state of mind will shed light on this task.

More so than I can recall in relatively recent memory, people in this country following 9/11 seem open to engaging in psychological process, self-evaluation, self-discovery and growth. The survey we conducted with Infinite Minds (slide 25) that I mentioned earlier clearly found that Americans, in seemingly unprecedented fashion, are re-examining their lives in light of events on September 11th. 71% reported having spent more time trying to gain perspective on their lives and 77% agreed that they are trying to simplify their lives and focus more on what really matters, such as family, relationships, and community.

Consumer focus groups we conducted in Indianapolis, Los Angeles and Baltimore in late October and November also found an expressed desire for self-discovery in the wake of the September terrorist attacks. Participants generally viewed self-discovery as a positive and beneficial process of realizing something about themselves that they didn't know they were capable of doing, or finding strength they didn't know they had.

We undertook these focus groups primarily for two reasons. First, in anticipation of continuing public education activities, we surmised that the events of 9/11 and subsequent threats of anthrax had created a new sense of uncertainty among the public, an assumption we wanted to check out. Second, we wanted to test whether our existing public education themes - - work stress, mind-body connection and family relations - - still resonated with people in a post-9/11 world. We did, indeed, find that these themes held strong with participants, in spite of all that happened. But, interestingly, although uncertainty was very much an issue for people, it was not felt to be a "new" uncertainty at all. Rather, people tended to acknowledge uncertainty as a continuing, albeit increasing, experience that now was seen as a way of life. Many participants also identified the presence of a chronic stress level, one which was described to be present before the terrorist attacks and not just as a result of them. All told, participants described a sense that the "other shoe is going to drop" compounded by the fact that they were already living with a chronic level of daily stress, resulting from pressures both at work and home. "It's in the back of my head everyday, what's next, when is it coming, I know it's coming," said one woman in the Baltimore focus group. Similarly, a man in the Los Angeles focus group said, "It scares me to look into the future."

But without question the strongest sentiment of all expressed by participants in the focus groups was the confidence that people will "bounce back" from the initial emotional and psychological impact of the attacks. Resilience, the term which we used to label the psychological process of successfully struggling with hardship, was viewed quite positively by the participants, and, importantly, people expressed a desire to learn how to be resilient. Participants were not so much interested in "coping" or "dealing with" or "living with" change and uncertainty as they were interested in being able to be "resilient" in the face of such challenges.

Prior to September 11th, the Directorate had been exploring the possibility of a PBS work-stress documentary to continue the activities and message of the Public Education Campaign. Although still a relevant message in a post-9/11 world, this now seemed too simple a picture of what was on the minds and hearts of the public. So it was back to the drawing board for a better vehicle to communicate psychology's role, a better way to demonstrate the value of psychological services and a new approach to help the public understand that their currently expressed need is well within the scope of psychological practice. The following excerpts from our recently crafted concept paper used for attracting a media partner begins to tell the more complex story now before us in this country.

The U.S. unemployment rate is now the highest its been in 21 years and economists say the 9/11 attacks had a devastating impact on the already weak U.S. economy. On the health front, despite new research and medical breakthroughs, one in four Americans will still die from cancer, and millions of families each year cope with children who have a disability or chronic illness. Now, there is also the continuing prospect of random terrorist attacks. And it's likely everyone will face one or more traumatic events in his or her lifetime.

But Americans are bouncing back from this latest trauma, as they always have. Research shows that a majority of people will return to their normal level of functioning from before the attacks. In fact, even people who have been affected directly by a traumatic event generally regain equilibrium within three years following the event.

Beyond just recovery though, a growing body of research is showing that most victims of trauma say life can be more meaningful than before the disaster struck. One clinical psychologist and researcher says more than half to two-thirds of trauma victims he has studied say they benefited from the trauma in some way. A study of survivors of a sunken cruise ship said the experience gave them new strength, while a study of Vietnam-era prisoners of war found that nearly two-thirds said they were stronger and wiser than they were before their captivity. The term "post-traumatic growth" seems to be taking its place along side post-traumatic stress.

Whether it's coping with the loss of a family member, maintaining a positive outlook in the face of a life-threatening illness, dealing with a job loss or having the wherewithal to carry their family through tough times, many people have a difficult time explaining what gives them their inner strength. In psychology, this inner strength is called resilience, and it's a characteristic that can indeed be learned.

Getting this message out to the public is the necessary next step in developing psychologists' role as guides for the psychological journey to find meaning in tragedies past, and to develop resilience against challenges yet to come.

In this vein, I am pleased to announce today that we have recently agreed in principle with cable television's Discovery Health (slide 26) to join forces in the production of a documentary on resilience and self-discovery. This documentary is intended to be first aired on September 11th, 2002, the one year anniversary of the terrorist attacks. In addition, the airing of the documentary will mark the kickoff of a grassroots outreach effort incorporated into our "Talk to Someone Who Can Help" public education campaign and working in coordination with all of you, much as we have with the "Warning Signs" outreach. While the specifics of this part of the campaign are still in the planning stages, it will likely include public service announcements, Discovery store displays and events, a brochure to support the documentary with fulfillment through an 800# and our Helping.apa.org Website, as well as additional materials about resilience on the Website.

We believe this effort to educate the public about resilience is consistent with APA President Phil Zimbardo's planned initiative to help the public see how psychology makes a significant difference in their lives. It also dovetails quite nicely with Board Member Ron Levant's newly formed Task Force on Promoting Resilience in Response to Terrorism which intends to put state of the art material on developing resilience into the hands of practitioners. After all, to the extent that we communicate to the public through a public education effort that resilience can be learned, it will be critical that psychologists are well prepared to help with that learning process.

In any event, as a result of what we have learned since September 11th, we are taking the Directorate's public education campaign to the next level, one which builds on what came before, expands the message of the campaign and, hopefully, extends the reach of the campaign. But even more importantly, I believe the time has come for our profession to move to the next level as a result of what has been experienced and learned since the terrorist attacks. Perhaps never before have people been so open to the very psychological processes about which we are expert. Perhaps never before have people been so interested in taking the psychological journey for which we are uniquely trained to act as guides. And perhaps never before has the help we have to offer seemed so mainstream and so much a part of the new "normal". Whether it's helping people find meaning in the tragic attacks on the World Trade Center and the Pentagon, or helping individuals build resilience in the face of a continuing threat that the other shoe is about to drop, or arming people with psychic protection against the adverse health affects of chronic stress, we, now more than ever before, have both an opportunity and a responsibility to make a contribution to the most significant issues of our time. But in order to do so, we must restrain our own individual self-interest and put aside our professional differences so that we do not inadvertently shirk our responsibility or squander this opportunity. We must come together as a psychology community like never before if we are to effectively help strengthen resilience in other communities. I am confident that we can do this. I am confident that our profession will rise to this occasion. Many are counting on us.