I, too, would like to welcome you to Washington and to this year’s State Leadership Conference, Health and Behavior: Taking Psychology Back to the Future.

To put this year’s theme in historical context, recall that two years ago our focus was “Staying the Course in Uncertain Times.

I suggested at that point that in fluid and uncertain times, staying the course we had charted in recent years was perhaps a better alternative than adopting strategies to change course.

Last year, our focus was “Strategic Resilience for the Profession: Getting a Jump on Change.”

At that time, I suggested we meet change with change, that we build an ingrained agility and flexibility to allow us to change in evolutionary and incremental ways, while avoiding the necessity of having to undergo major upheaval or cataclysmic shifts.

This strategy included finding alternatives to the traditional ways of doing business or to the traditional ways of practicing (2).

Some of you may now be saying to yourselves,
“So if I have this straight, first he said we shouldn’t change.

Then he said we should change.

We realize this is Washington and you have to be able to keep your options open, but which is it?”

You will be pleased to know that this year’s conference has the definitive politician’s answer to the question of whether to stay the same or change -- the answer is it’s both stay the same and change.

This year’s conference theme conveys a broad vision for psychology’s future, one that is replete with new and diverse activities, but one that also takes advantage of our profession’s tradition and rich heritage.

And, we believe it is a vision of the future which takes into account significant trends in healthcare and in the world around us.

The public focus that is now being placed on the effects of lifestyle, behavior, and stress on health and illness is unprecedented (3).

The “mind-body connection,” as it is often referred to by the public, is for the first time receiving mainstream media coverage. Also for the first time, real dollars are starting to flow into prevention, health promotion, and disease management, areas where behavior and behavior change provide the foundation for assuring health and treating illness.

Policy makers are even looking to these areas for solutions to the country’s broken healthcare system.

Just recently, the Robert Wood Johnson Foundation concluded that “The United States needs to develop a proactive approach for health, focusing on prevention of illness and injury….

This type of approach would save lives and money and improve our overall health.”

Integrating mind with body, behavior with health and the psychological with the physical all hold a credible promise of achieving the long sought after elusive goal of improved health care while simultaneously controlling, if not reducing, healthcare costs.

A future healthcare system that relies on connections between behavior and health reaches squarely back into psychology’s past (4). What policy makers and the public are now just starting to realize, psychology has known for years if not decades -- the research, the knowledge base, and technologies to change behavior in ways that benefit people’s health do exist.

And, much of the research, the knowledge base, and the technologies are psychology’s work.

More about the implications of that for our profession’s future in a few minutes.

Since last year’s State Leadership Conference, some milestones have been reached, some progress made, and some disappointments experienced.

The prescription privileges agenda continues to see great strides accomplished.

Everyone, I hope, knows by now that last May, Louisiana became the second state -- joining New Mexico and the territory of Guam -- to enact a prescriptive authority law.

What everyone may not know is that just this past January, both Louisiana and New Mexico successfully completed implementation of these laws, with final rules and regulations becoming effective (5).

Psychologists in these states are now becoming certified to prescribe, and just recently, Louisiana medical psychologist Dr. John Bolter was caught on film being the first to write a prescription under the new law.

Congratulations to all in New Mexico and Louisiana who participated in these hard fought victories.

Of course, our work is far from over.

After some determined finger pointing over at the American Psychiatric Association headquarters in the wake of organized psychiatry’s defeat in Louisiana, that organization has been redoubling its opposition.

According to little ApA President Michelle Riba, an “expanded retreat” was held in June to consider psychology scope of practice issues.

The retreat led to the formation of a presidential task force and a statement to its members that concluded, as follows (6):

“For twenty years, through federal programs such as the Department of Defense, and by state legislation, organized psychology has relentlessly pursued efforts to gain prescribing privileges for its members…The prescribing threat is real and must be fought with renewed vigor, commitment, and tenacity involving not just the national and ApA leadership, but every local psychiatrist.” (August, 2004)

I, for one, look forward to our continuing relentless pursuit of prescribing privileges and to the legislative fights we are engaging this year in Hawaii, Tennessee, Connecticut, Illinois, Oregon, Wyoming, Missouri, as well as again in New Mexico to improve the law’s current definition of “psychoactive medication.”

Other good legislative work has been occurring on the state front as well.

Through the work of their psychological associations, West Virginia and Georgia joined Florida by enacting good faith immunity laws for court appointed psychologists doing custody evaluations.

These laws offer protection for psychologists conducting evaluations performed consistent with the recommendations set forth in APA’s Guidelines for Child Custody Evaluations in Divorce Proceedings.

In a somewhat ironic twist, psychiatrists in West Virginia asked to be included under the law’s coverage (7).

This then means that the psychiatrists must now practice consistent with psychology’s guidelines for child custody evaluations in order to receive immunity.

In New Jersey, after several years of work by the New Jersey Psychological Association, the New Jersey Supreme Court adopted rules allowing a psychologist to be utilized in place of one of the two physicians previously required for capacity determinations in guardianship hearings.

Elsewhere, Missouri passed a comprehensive mental health parity law this year, becoming the 19th state to successfully enact broad-based parity.

And, Washington State expects to be the 20th state as the governor is anticipated to sign a comprehensive mental health parity law late next week.

Speaking of Washington State, as part of a larger bill to eliminate barriers to the credentialing of health professionals, that state became the first to allow each of the required two years of supervised practical experience leading to licensure to be pre-doctoral (8).

And, the Colorado Psychological Association successfully fought back an attempt to reinstitute an omnibus licensing board in the state.

For the second year in a row, battling to prevent elimination of psychological services in Medicaid was the order of the day.

The New York State Psychological Association successfully stopped efforts to eliminate psychological services this year after having last year won increased funding for patients who are jointly eligible for Medicaid and Medicare.

The Georgia Psychological Association averted elimination of psychological services to children this year after last year reversing elimination of Medicaid psychological services in the Governor’s proposed budget.

The Maine Psychological Association also prevented elimination of psychological services but suffered a 16-session cap on adult outpatient services.

Washington State, with the help of Congressman Brian Baird, staved off an attempt by the Center for Medicare and Medicaid Services to ban the state from using Medicaid savings to serve more people, including those served by the community mental health centers (9).

And, the Ohio Psychological Association continued its hard-fought battle to get the legislature to restore cuts made last year.

Unfortunately, there is not likely to be an end to these fights to preserve Medicaid psychological services any time soon.

President Bush’s proposal to reduce Federal Medicaid spending by at least $45 billion over the next decade will create increased pressure for cutting costs and slashing services. The Practice Organization’s state advocacy and government relations staff have teamed up to build a comprehensive strategic plan for dealing with Medicaid psychological services, and we greatly appreciate all of your efforts in collaboration with us.

On the legal front, psychology continued to take an aggressive stand against problematic managed care practices.

In June, a three-judge panel of the DC Court of Appeals -- the District’s highest court -- heard oral arguments in the case of Virginia Academy of Clinical Psychologists v CareFirst (10).

You’ll recall this lawsuit alleged breach of contract with both psychologists and subscribers, consumer fraud and punitive damages.

The contract claims were settled successfully, but the fraud and punitive damage claims were dismissed by the trial court.

The appeal challenges the dismissal of these claims.

At issue in this appeal is a challenge to the courts’ common view of managed care arrangements in purely contractual terms without regard to the affect those terms have on quality or access to patient care.

This common law view, unfortunately, leaves managed care companies unaccountable for policies and practices that put profits ahead of patients.

The VACP case alleges that, beyond just a simple breach of contract, CareFirst made fraudulent coverage promises to its subscribers with no intention of providing the services promised.

We continue to await the Court’s ruling.

In July, the Florida Psychological Association became a plaintiff in class action litigation against 63 BlueCross-Blue Shield companies throughout the country(11).

This case, brought in federal court in Miami and based on the Racketeer Influenced and Corrupt Organizations Act -- or RICO, as it is known -- alleges that these companies conspired to reduce and delay payments for services rendered by non-physician health professionals, including psychologists.

The Practice Organization has also been involved in a companion class action case against the nation’s 10 largest managed care companies, including AETNA, CIGNA, Humana, Anthem, and United Healthcare, which alleges similar conspiracy charges and violations of RICO.

In December, we became a signatory to a settlement agreement with CIGNA growing out of this case.

In return for dismissing claims against CIGNA, the company established an $11.5 million settlement fund for payment to the class members.

The class consists of non-physician health professionals, including psychologists, who between January 1, 1990 and December 29, 2004 provided covered services to CIGNA members or to anyone covered by a plan from any of the other nine defendants in the case (12).

Importantly, the settlement also includes policy changes to be made by CIGNA which are intended to improve the company’s medical necessity procedures and improve administrative procedures to make doing business with the company easier and faster.

If you or any of your members believe you may be eligible to participate in this settlement, you can find more information on the Practice Organization web portal.

I would add that we are optimistic that other of the remaining defendants will also see the wisdom of settling as well.

Perhaps our biggest disappointment of the year was the failure of Congress to pass the Paul Wellstone Mental Health Equitable Treatment Act.

Despite a commitment from the Senate leadership to bring the bill to the floor -- a commitment secured by long-time parity champion New Mexico Senator Pete Dominici -- neither chamber did so.

But momentum did continue to build throughout the year (13).

With the urging of literally hundreds of organizations, 70 Senators and 249 Representatives co-sponsored the bill.

And, if those numbers don’t convince you that this is a bipartisan issue, both the Democratic and Republican Party platforms for the 2004 presidential elections included mental health parity.

While we may now have a new Congress, because of the work that has been done, this issue will definitely not be new to it.

You will hear much more about that during the course of the conference.

Suffice it for me to say I believe this to be the year that discrimination is outlawed and full parity for mental health finally becomes this country’s law.

This past year in Congress, with strong leadership from Ohio Senator Mike DeWine and Representative Ted Strickland, we won passage of the Mentally Ill Offender Treatment and Crime Reduction Act.

This new law authorizes a $50 million grant program for more mental health courts, treatment and jail diversion programs, and re-entry programs (14).

The resulting programs build on the existing mental health courts program started by Representative Strickland for which we also helped secure continued funding.

While patient protection and managed care accountability legislation have been non-starters in a Congress gearing up for an attempt to pass malpractice reform, we have been able to successfully stall Association Health Plan legislation.

Despite the intention to make insurance coverage more accessible, if passed, AHPs would preempt state level patient and consumer protections, mandated mental health benefits laws, and all state parity laws.

Continued efforts will be necessary to ensure that AHPs do not undo our hard-fought victories at the state level, and you will hear more about that during the course of the conference as well (15).

In a somewhat new tactic on the federal level, the Practice Organization, with the help of the Pennsylvania Psychological Association, won Congressional seed money for a demonstration project in a Pennsylvania hospital to integrate mental health screening and treatment with primary medical care for older adults.

Given Congress’ increased interest in supporting demonstrations based on the integration of behavior and health, we believe that continuing this funding tactic has good merit.
Other possible demonstration projects on tap to use Congressionally appropriated money to showcase psychological services include psychological interventions in the treatment of Medicare cardiac patients and the treatment of childhood obesity in school-based health centers.

Prior work on the Medicare front is now beginning to pay dividends.

Medicare’s acceptance of our health and behavior CPT codes in 2002 did not automatically mean widespread use of the codes which recognize psychologist’s ability to provide health services to health disorders in the absence of a mental health diagnosis.

Yet, increased use since their creation has been quite apparent (16).

The number of health and behavior claims submitted by psychologists to Medicare increased almost 400 percent from 64,000 claims in 2002, the first year they were available, to over a quarter of a million claims in 2003.

Medicare reimbursements to psychologists for these services skyrocketed from $1.56 million to $6.1 million in a year’s time.

Progress in the private insurance market has been much slower since each company makes its own determination about accepting the codes.

To date, 17 private insurers are accepting the health and behavior codes, and with your help, we will continue to increase that number.

While we certainly have our work cut out for us to achieve universal acceptance of the health and behavior codes, the importance of this mechanism for psychology’s future cannot be over stated.

Having a way to explicitly recognize and reimburse psychological services delivered to health, not just mental health, conditions is an absolute prerequisite for our profession’s role in a healthcare system beginning to capitalize on the relationship between behavior and health (17).

But, more about that in a minute.

Our work to better develop psychology’s political giving capacity is also beginning to bear fruit.

Among the most important reasons for creating the Practice Organization as a 501 (c) (6) tax-exempt companion to the APA was to enable us to engage in political giving activity.

And, you will recall that the affiliation agreement struck last year with the Association for the Advancement of Psychology allowed us, for the first time, to solicit contributions to AAP/PLAN -- psychology’s major political action committee -- from those of you who are members of the Practice Organization but not AAP members.

I am delighted to report that our first solicitation brought in approximately $90,000 for the PAC.

Importantly, close to 900 Practice Organization members, who were not AAP members, made contributions.

Also of note, over 300 Practice Organization members with no prior history of contributing to any of the Practice Organization’s fundraising responded to this appeal (18). While we must continue to grow, this type of increased participation in political giving is exactly what our profession needs to improve our access and impact with members of Congress.

By the way, should you think this increased participation by Practice Organization members means you no longer need to pay your dues to AAP, think again.

Simply put, it costs money to raise money.

Without the critical dollars for administering the PAC and supporting solicitations -- dollars which come from AAP dues -- we either must take money away from the actual dollars intended to go directly to Members of Congress or take money away from other advocacy activities.

So, please continue to maintain all of your professional memberships. They are all important (19).

This past year also witnessed continued growth in the Psychologically Healthy Workplace Award program, with 39 states, provinces, and territories participating, and more than 200 organizations having been recognized for their psychologically healthy workplaces.

2004 marked the second annual Best Practices Honors which recognized the top 10 innovative programs promoting employee health and well being from among the many Psychologically Healthy Workplace Award winners.

The program is now poised to take the next step in its development -- a national level APA psychologically healthy workplace award, which will be given in 2006 to companies selected from among state, province, and territory winners.

I am delighted to announce publicly for the first time that plans are already underway to hold that event during next year’s State Leadership Conference.

And, as you know if you’ve seen the article entitled “A New Health Care Prescription” in the late January issue of Fortune, the media is beginning to spread our message about the benefits of a psychologically healthy workplace.

That media message in Fortune is actually a harbinger of things to come in the soon to be launched next iteration of our ongoing public education campaign (20).

While resilience campaign activities have continued, including recent forums for 1200 students of the Fort Belvoir school in Virginia, we have been developing new materials and new messages for a campaign that will focus on the unique and central role of psychologists at the intersection of the psychological and the physical, or the mind-body connection (20).

We believe this campaign can take good advantage of the current popularity of mind-body health, will showcase what psychologists have to offer and will provide a campaign umbrella for a broad range of education, including psychology’s science base, our work in mental health, physical health, wellness, resilience, prevention, disease management, and even the psychologically healthy workplace.

Importantly, with tag lines such as, “For a Healthy Mind and Body, Talk to a Psychologist,” we believe this campaign will contribute greatly to APA President Ron Levant’s mission to make psychology a household word (21).

Other activities of note this past year include the Disaster Response Network responding to the numerous Florida hurricanes and involvement with the tsunami relief effort.

The State Leadership Conference Diversity Delegate program produced its third state association President as BraVada Garrett-Akinsanya of Minnesota joined past delegates Jan Owens-Lane of Connecticut and June Ching of Hawaii as elected leaders of their associations.

Good progress has occurred with our work to develop the procedure manual to implement the World Health Organization’s International Classification of Functioning, Disability, and Health, known as the ICF.

Also as a result of our work with WHO during this project, we have recently been invited to be a central participant in the revision process of the International Classification of Diseases, leading to the what will be the ICD-11.

And, last but not least, the Practice Organization’s portal continued to grow with just under 20,000 psychologists registered at the site.

Among other things, we are developing new online materials to help practitioners comply with the HIPAA Security Rule set to be in force on April 20th(22).

And, we are about to launch a turnkey web-site product for psychologists who wish to build a web site to promote their practices.

Much has occurred during the past year.

And we in the Directorate owe a sincere debt of gratitude to all of you who have been working to both stay the course and get a jump on change.

We are particularly grateful to the Committee for the Advancement of Professional Practice for its guidence and unwaivering support and to the Directorate’s networks -- the Federal Advocacy Coordinators Network, the Public Education Campaign network, the Business of Practice Network and the Disaster Response Network -- for helping to expand our reach, our message and our work across the country.

But now, I want to turn our attention to this coming year, and beyond.

Much to our chagrin, no good comprehensive health reform plan, or even an organized vision of one, seems able to emerge in response to recent years of turmoil in the country’s health system (23).

Some analysts are pointing to the rise in activity of consumer-driven healthcare to be a developing direction for the healthcare system.

You will recall the concept of a consumer-driven health plan to be the opportunity for individuals to be better enabled as the purchasers of their health services, not just the consumers of services purchased for them by a third party.

The concept is intended to produce an informed consumer of health care who will make smart purchasing choices based on quality and cost.

It is typically a high deductible insurance plan with a combined employer and employee funded health reimbursement account used by the employee to pay for expenses within that deductible.

Designated preventive care often times can be accessed at no out-of-pocket cost to the employee.

Funds remaining at year-end can be rolled into subsequent years.

An employer poll conducted by Business Insurance found that over 38% of respondents plan to offer a consumer-driven health plan in 2005.

Consumerism drivers include double-digit premium hikes, employers wanting to lower their healthcare costs, and 45 million uninsured.

The hope is that consumer-driven healthcare will provide some help for these problems and will replace HMOs and PPOs in the process (24).

But concept is one thing and implementation is quite another.

The most frequent version to date of a consumer-driven health plan -- the Administration’s Health Savings Accounts or HSAs -- has been met with mixed reviews.

It is thought by some to be at best untested and at worst an unlikely solution to the healthcare system’s woes.

A recent Families USA issue brief entitled “Why High Deductible Plans are Not the Solution,” concludes that HSAs are more a problem than a solution.

While political and market forces continue to wrangle to determine an effective version of consumer-driven healthcare, perhaps there is another approach to help solve the healthcare system’s cost, coverage,
and access problems, an approach that is much closer to home -- psychology’s home (25).

The impact of behavior on health and illness which is now being taken seriously by the public, payers and policy-makers, provides an opportunity for the country’s healthcare system to address cost and quality problems.

Importantly, the recognition of the relevance of behavior also provides psychology an opportunity to play a more central role in the healthcare system.

In addition to the growing recognition of the connection between health and behavior, structures which have previously been built to keep behavioral health and physical health separate are now being dismantled.

The creation of the health and behavior codes has contributed to this.

Also, insurers are beginning to eliminate behavioral health carve-outs in order to integrate medical and behavioral services.

Just recently, it was reported that Blue Cross and Blue Shield of Massachusetts eliminated its Magellan carve-out contract for almost half a million subscribers who work for state-based companies (26).

A company spokesperson pegged its move to the desire to have the ability to look at both medical and behavioral health claims when developing disease management programs to improve members’ health care.

Even the managed behavioral healthcare carve-outs are themselves developing more disease management capabilities.

The change, says one industry publication,
“is driven by several factors, including medical evidence that shows a synergistic effect between mental health and medical conditions, increasing respect for the impact disease management programs can have on health outcomes and medical costs; and more pressure on insurers to slow premium increases.”

And, it has been reported that Medicaid will increase to 28 the number of states that have adopted some form of disease management for their Medicaid populations, a 55% increase over last year (27).

But the role of behavior -- and by relationship, the role of psychology -- goes far beyond disease management.

Behavior is integrally linked with the promotion of health and the prevention of disease.

While this is definitely not a new understanding within our ranks, the growing public understanding is new.

Much more prominent today is the realization that the six leading causes of death are related to behavior -- heart disease, cancer, liver disease, lung disease, car crashes, and suicides.

Some 60-90% of visits to a medical doctor, depending on which study you look at, are considered to be for stress-related complaints.

43% of all adults suffer adverse health affects from stress.

People are beginning to understand,
perhaps for the first time, that things such as having a good support system or maintaining an optimistic outlook on life lead to better health and even to longer life, as described by our CEO Norman Anderson in his book Emotional Longevity.

Corporate America has taken note of the growing role of lifestyle and behavior in health (28).

Wellness programs are springing up in the workplace as companies look to promote employee health and to positively influence their financial bottom line.

Perhaps as a testament to how influential lifestyle and behavior have become, even some corporate marketing departments are taking note.

One large, well-known food company, for example, recently presented elements of its new marketing strategy to a gathering of health industry and consumer advocates.

It described three categories of products being sold to consumers: “good-for-you-foods”, such as oatmeal and orange juice, with known health benefits;
“better-for-you-foods”, which have undergone processes to squeeze out as much of the saturated fats and sugar as possible; and “fun-for-you-foods”, which are, you guessed it, those foods likely to contain little else besides fat and sugar (29).

The real point to be made here is that the company is redistributing its marketing dollars away from the historical consumer favorite
fun-for-you-foods and towards the better-for-you and good-for-you foods.

This change, of course, is designed to reflect consumers’ changing, behaviors, priorities, and purchasing patterns.

As I said before, an understanding of the connection between behavior and health is not new to our profession.

In fact, psychologists have been among the first to produce the evidence leading to this understanding or to have fashioned interventions which incorporate it.

There are likely few among us who do not recall the early work of Neal Miller which demonstrated instrumental learning of visceral responses and led to biofeedback treatment for hypertension,
cardiac arrhythmias, gastrointestinal symptoms, and headaches.

We are also well aware of the field of health psychology which did much to chart the influence of behavior, lifestyle or personality on diseases such as diabetes, asthma and cardiovascular disease, leading to better management of those diseases (30).

And, we are more than familiar with the areas of neuropsychology and rehabilitation psychology, both of which have contributed greatly to the knowledge of brain-behavior relationships.

Of course, there have been others besides psychologists who have been instrumental in linking mind and body.

Forty years ago, a young research and clinical cardiologist named Herbert Benson began investigating a connection between stress and hypertension and discovered that monkeys could be trained to regulate their blood pressure levels with brainpower alone.

This eventually led to the publication in 1975 of The Relaxation Response which offered a useful application of the mind-body connection to a curious public but a highly skeptical Western medical establishment.

No doubt we will hear more about that later from Dr. Benson.

But our focus today and for the conference this weekend is not so much on how we know what we know or when we knew it, as it is on how to effectively use what we know in today’s healthcare environment (31).

And, while we may have the necessary knowledge, we will likely need to change the way we use it in order to be maximally effective today and in the future.

For a number of State Leadership Conferences, I have been urging us to move beyond the narrow conception of ourselves as mental health professionals and to begin to see ourselves as comprehensive health professionals. I believe this is critical to our future.

And, I would emphasize that this does not mean practicing as health professionals in place of mental health professionals but, rather, in addition to it.

But, I would also urge us now to take that a step further and to begin to see ourselves more as experts in behavior to most effectively use what we know and to maximize our impact and opportunities in a healthcare environment increasingly aware of the important role of behavior. As before, this conception of ourselves is not intended to replace our practice as mental health and health professionals, but instead encompass and enhance it (32).

Our ability to effectively address problems of behavior with individuals, groups, organizations, systems, or even populations also has implications beyond health and mental health. But, I will leave those for another day.

So how exactly do we bring our expertise in behavior to bear on the delivery of healthcare services at a time when the relationship between health and behavior is coming into sharper focus?

The good news is there is not just one way to accomplish this.

The bad news is there is no clear single way to do it. It will require creativity, flexibility, innovation, persistence and strategic resilience, both from individual psychologists and from our organizations.

One example of an innovative approach based on psychologists' expertise in behavior has recently been described by Dr. Jim Prochaska, from whom we will be hearing more later today.

In an effort to increase psychology’s impact in the healthcare system, he has described a “more comprehensive and integrative approach to health and mental health behaviors that would complement traditional paradigms by adding proactive approaches to reaching entire populations (33).”

While I do not want to steal Dr. Prochaska’s thunder, I do want to underscore some key principles of this approach as it may provide a model of how to effectively use what we know to meet today’s healthcare challenges.

According to Dr. Prochaska, most health care practices follow a passive-reactive paradigm where health professionals wait for patients to approach them, usually with an acute condition of some kind.

This works relatively well with people in distress but not with people whose health risk behaviors -- poor diet,
no exercise,
smoking,
alcohol use, to name a few -- do not produce acute distress and who are, therefore, not motivated to seek help.

No matter how efficacious treatments may be with patients who chose to come to our office for help, they will never be effective with people who do not seek treatment.

By the way, this notion has profound implications for how we understand the concept of evidence-based practice (34).

But the point here is that we need to proactively reach out to people to address those risk behaviors that affect their health.

Yet, even a proactive approach armed with the necessary knowledge of the connections between behavior and health will not be sufficient if we do not consider those behaviors that the majority of people are not ready to change.

Despite what we have known for years from
Dr. Prochaska’s model about people’s readiness to change -- that people move through a series of stages from pre-contemplation to contemplation to preparation to action and maintenance -- we frequently expect people to stop their risk behaviors just for the asking.

While successful marketing may have convinced us we live in a
“Just Do It” culture, not everyone can just do it.

And, those who can’t, are contributing greatly to the rising costs of healthcare in this country as a result of illnesses that might otherwise have been prevented or alleviated.

Failed attempts to change behavior also contribute to the public’s skepticism that behavior can really change (35).

Proactive outreaches to offer help, therefore, need to also include messages that are matched to the needs of those who are ready to change, getting ready to change, or not yet ready to change.

Anyone familiar with the transtheoretical model of change knows that we have the research and the knowledge base to do just that.

Finally, treatments need to be easily accessible.

One way to make psychological treatments more accessible is to integrate these treatments directly into existing primary care, an approach the Committee for the Advancement of Professional Practice and the Practice Directorate have been encouraging for over a decade.

According to Dr. Prochaska, another way to make treatment accessible is to include a component that is home-based.

The use of information technologies will enable this.

But, so, too according to Dr. Prochaska, will prescription privileges for psychologists whereby, the benefits of medication taken at home would complement the treatment received in psychologists’ offices (36).

As I said before, this is just one innovative approach to increasing psychology’s relevance and impact in the current healthcare system.

We need to find others.

That is the challenge I offer to you during this conference and in the months ahead as leaders of your organizations --
to find ways your organization and your members can increase psychology’s relevance and impact.

As you take up the challenge -- and I really hope you do accept this challenge -- it may help to keep certain things in mind.

First, our nation is increasingly preoccupied by virtual epidemics of health conditions, such as obesity and diabetes, in which behavior plays a significant role in both their cause and their effective treatment.

Second, our country is desperately looking for strategies to control healthcare costs without sacrificing quality of care or quality of life.

Third, consumers are spending billions of dollars -- much of it out of pocket -- on mind-body remedies (37).

Fourth, by some credible reports, this is a time in our health system’s history when non-physician clinicians are becoming prominent health providers and have advanced into territory once held solely by M.D.s.

And, finally, psychologists have a far broader range of expertise in behavior than we have been given credit for -- worse yet, far broader than we have given ourselves credit for.

All tolled, this sounds to me like an opportunity for us.

The one question remains, though, whether this is an opportunity our profession will seize.

To do so will require that we innovate and be willing to practice differently than in the past, not so much with entirely new skills as in new settings and with new approaches to the way we use the skills we have.

Yet, while it is clear from our surveys of members that many, if not most, practitioners want things to be different, their readiness for change and to practice differently varies greatly.

Some are prepared to take action now while others are mired in precontemplation (38).

Without being too melodramatic, the image brought to mind for me is of a mountain climber who has traveled a great distance on a steep, vertical upward climb only to find that the path goes no further.

The climber remains stalled with a solid two-handed grasp of the ledge above, in no danger of falling but with no prospect of advance either.

Suddenly, a rope appears to the climber’s side -- it is a rope that can pull the climber along a new path and to new heights.

But, to grab that rope, the climber must let go of the secure ledge with at least one hand.

The climber must trust that one hand on the ledge is sufficient to hold on.

And, the climber must have faith that the rope will actually lead to a new path and to new heights.

That climber is us
-- all of us --
as we are in this together.

And, the cord that ties health and behavior is the rope next to us.

But time is of the essence.

That rope will not dangle within psychology’s reach for long.

We must figure a way to help our members prepare to take action to grab that rope.

We must figure a way for our members to have faith that the rope will lead to new heights.

And, we must figure a way for our profession to use what we know to seize this opportunity. Psychology’s future depends on it. The health of our country depends on it.