Pat DeLeon’s Article- EXCITING CHALLENGES LEAD TO UNIQUE OPPORTUNITIES
EXCITING CHALLENGES LEAD TO UNIQUE OPPORTUNITIES
If truth be known, public service psychologists have fascinating lives. Professionally, we are only limited by our vision, enthusiasm, and willingness to remain focused upon our individual agency's underlying mission. Public beneficiaries often provide unique and challenging opportunities. At the same time, governments (i.e., both state and federal) possess financial, technical, and personnel resources that are simply unavailable in the private sector. The federal government's increasing investment in cutting-edge computer technology, telehealth capabilities, virtual realities, as well as the resources necessary to effectively respond to natural and other disasters is unmatched anywhere in the world. Each of our nation's health professional training disciplines have historically relied upon the public sector for their students' clinical placements. State and federal legislators � not to mention progressive labor unions for some of our colleagues � appreciate that they are ultimately responsible for providing the necessary resources, as well as ensuring productive and satisfying working environments.
Perhaps most exciting are the clear signs that the public sector is increasingly providing a real opportunity for creative visionaries to develop (and evaluate) unprecedented holistic-oriented healthcare environments which will be consumer-focused and based upon critical public health principles. "How else can we ever hope to curtail the ever-escalating costs of health care or take care of our new and growing generation of senior citizens?" public health experts would ask. Those colleagues interested in the history of the expansion of non-physician scopes of practice will appreciate the historical (and ongoing) opportunities for all disciplines to demonstrate their clinical competence, based upon their core training and objective measures. Our nation's federally qualified community health centers and the Department of Defense (DoD) psychopharmacology training initiatives (RxP), for example, are providing our next generation with the opportunity to obtain innovative and highly exciting interdisciplinary (i.e., collaborative) clinical experiences, leaving behind traditional isolated professional "silos." The February APA Monitor story describing the efforts of the U.S. Public Health Service to bolster the number of PHS Commissioned Corps officers at military hospitals represents another exciting opportunity for our new graduates. I am, of course, acutely aware of organized medicine's continuing efforts to "turn back the tide" and remain "captain of the ship." However, I am confident that the 21st century, with its new generation of educated consumers and highly trained and articulate non-physician providers embracing the unprecedented advances occurring within the communications and computer fields � such as electronic health records (EHRs) � will make their quest herculean, if not impossible. Our Special Rural Responsibility: A long time friend and professional colleague, who has also served extensively in the public sector on Capitol Hill, has gone on to administer several rural health initiatives, most recently as Chair of the Center for Rural Health at the University of North Dakota. Mary Wakefield is a member of the Institute of Medicine (IOM) and served as chair of their 2005 report Quality Through Collaboration: The Future Of Rural Health. "In too many ways, rural communities have been at the margins of the health care quality movement. Most quality initiatives in the United States have been developed with urban health care features in mind and as a result have not always been directly applicable to rural health care settings.... For example, inpatient care in rural hospitals is often a smaller part of the total set of services than is the case in urban hospitals. Smaller case volumes and long-standing shortages of key health care services, such as those for mental health and substance abuse, draw a mix of providers different from the norm in urban settings. Historically, moreover, the financing of rural health care has been a particularly fragile endeavor.... While acknowledging these challenges, the [IOM] has charted an agenda for rural communities that fulfills the six aims set forth in the 2001 IOM report... of making health care safe, effective, patient-centered, timely, efficient, and equitable. This agenda also reflects the need to improve both the quality of personal health care and the health of the rural population as a whole, as well as to apply the newest tools available, such as information technology, to the work of delivering high-quality care in rural settings.... Among the profound changes needed to achieve these aims are that information technology must play a central role in support of the delivery of care...."
"Rural America is a vital component of American society. Representing nearly 20 percent of the population, rural communities, like urban landscapes, are rich in cultural diversity. From the Native American Indian tribes and Hispanic communities of the southwest, to the African American communities of the Mississippi Bayou, to the Amish settlements of Pennsylvania, to the European descendants of the Great Plains, rural communities are home to many of the earliest Americans, as well as more recent immigrants. Rural communities are heterogeneous in other ways as well, differing in population density, remoteness from urban areas, and economic and social characteristics. ... In many respects, rural communities have been on the periphery of discussions of national health care quality. A roadmap for applying the quality agenda now evolving at the national level to sparsely populated areas is needed.... The IOM committee also wants to draw special attention to the very limited availability of mental health and substance abuse services in many rural communities, which is likely attributable in part to a lack of adequate funding. The committee recognizes that this is a complex area. The mental health needs of populations are diverse, and mental health care services are provided in both general and specialized settings and by a plethora of health care professionals. "
Mary's committee is aware of a wide range of interventions that are available to improve health and health care in rural America and points out that priorities for implementation are not yet clear. There is a significant need in rural communities, and especially in those interested in health systems redesign, for leadership training and learning from the efforts of others that have been successful. Workforce training should ensure that all health care professionals master the core competencies of providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. Telehealth capabilities possess particular potential for providing outstanding teaching and mentoring opportunities for our senior colleagues. In so many ways, our nation's rural communities can serve as living laboratories for social change.
As psychologists and as behavioral scientists, we should be particularly sensitive to the fact that our future is directly tied to our research and knowledge dissemination efforts. Accordingly, the associate editors of our Division's journal Psychological Services (Shelia Brandt, Leon Green, Jill Oliveira, Morgan Sammons, Gary VandenBos) and I strongly urge you to commit your experiences to print and submit an article to the journal, especially sharing relevant data. It is critically important that we communicate with each other, across programs and institutions, about the lessons we have learned in serving our public beneficiaries.
EXCITING CHALLENGES LEAD TO UNIQUE OPPORTUNITIES
If truth be known, public service psychologists have fascinating lives. Professionally, we are only limited by our vision, enthusiasm, and willingness to remain focused upon our individual agency's underlying mission. Public beneficiaries often provide unique and challenging opportunities. At the same time, governments (i.e., both state and federal) possess financial, technical, and personnel resources that are simply unavailable in the private sector. The federal government's increasing investment in cutting-edge computer technology, telehealth capabilities, virtual realities, as well as the resources necessary to effectively respond to natural and other disasters is unmatched anywhere in the world. Each of our nation's health professional training disciplines have historically relied upon the public sector for their students' clinical placements. State and federal legislators � not to mention progressive labor unions for some of our colleagues � appreciate that they are ultimately responsible for providing the necessary resources, as well as ensuring productive and satisfying working environments.
Perhaps most exciting are the clear signs that the public sector is increasingly providing a real opportunity for creative visionaries to develop (and evaluate) unprecedented holistic-oriented healthcare environments which will be consumer-focused and based upon critical public health principles. "How else can we ever hope to curtail the ever-escalating costs of health care or take care of our new and growing generation of senior citizens?" public health experts would ask. Those colleagues interested in the history of the expansion of non-physician scopes of practice will appreciate the historical (and ongoing) opportunities for all disciplines to demonstrate their clinical competence, based upon their core training and objective measures. Our nation's federally qualified community health centers and the Department of Defense (DoD) psychopharmacology training initiatives (RxP), for example, are providing our next generation with the opportunity to obtain innovative and highly exciting interdisciplinary (i.e., collaborative) clinical experiences, leaving behind traditional isolated professional "silos." The February APA Monitor story describing the efforts of the U.S. Public Health Service to bolster the number of PHS Commissioned Corps officers at military hospitals represents another exciting opportunity for our new graduates. I am, of course, acutely aware of organized medicine's continuing efforts to "turn back the tide" and remain "captain of the ship." However, I am confident that the 21st century, with its new generation of educated consumers and highly trained and articulate non-physician providers embracing the unprecedented advances occurring within the communications and computer fields � such as electronic health records (EHRs) � will make their quest herculean, if not impossible. Our Special Rural Responsibility: A long time friend and professional colleague, who has also served extensively in the public sector on Capitol Hill, has gone on to administer several rural health initiatives, most recently as Chair of the Center for Rural Health at the University of North Dakota. Mary Wakefield is a member of the Institute of Medicine (IOM) and served as chair of their 2005 report Quality Through Collaboration: The Future Of Rural Health. "In too many ways, rural communities have been at the margins of the health care quality movement. Most quality initiatives in the United States have been developed with urban health care features in mind and as a result have not always been directly applicable to rural health care settings.... For example, inpatient care in rural hospitals is often a smaller part of the total set of services than is the case in urban hospitals. Smaller case volumes and long-standing shortages of key health care services, such as those for mental health and substance abuse, draw a mix of providers different from the norm in urban settings. Historically, moreover, the financing of rural health care has been a particularly fragile endeavor.... While acknowledging these challenges, the [IOM] has charted an agenda for rural communities that fulfills the six aims set forth in the 2001 IOM report... of making health care safe, effective, patient-centered, timely, efficient, and equitable. This agenda also reflects the need to improve both the quality of personal health care and the health of the rural population as a whole, as well as to apply the newest tools available, such as information technology, to the work of delivering high-quality care in rural settings.... Among the profound changes needed to achieve these aims are that information technology must play a central role in support of the delivery of care...."
"Rural America is a vital component of American society. Representing nearly 20 percent of the population, rural communities, like urban landscapes, are rich in cultural diversity. From the Native American Indian tribes and Hispanic communities of the southwest, to the African American communities of the Mississippi Bayou, to the Amish settlements of Pennsylvania, to the European descendants of the Great Plains, rural communities are home to many of the earliest Americans, as well as more recent immigrants. Rural communities are heterogeneous in other ways as well, differing in population density, remoteness from urban areas, and economic and social characteristics. ... In many respects, rural communities have been on the periphery of discussions of national health care quality. A roadmap for applying the quality agenda now evolving at the national level to sparsely populated areas is needed.... The IOM committee also wants to draw special attention to the very limited availability of mental health and substance abuse services in many rural communities, which is likely attributable in part to a lack of adequate funding. The committee recognizes that this is a complex area. The mental health needs of populations are diverse, and mental health care services are provided in both general and specialized settings and by a plethora of health care professionals. "
Mary's committee is aware of a wide range of interventions that are available to improve health and health care in rural America and points out that priorities for implementation are not yet clear. There is a significant need in rural communities, and especially in those interested in health systems redesign, for leadership training and learning from the efforts of others that have been successful. Workforce training should ensure that all health care professionals master the core competencies of providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. Telehealth capabilities possess particular potential for providing outstanding teaching and mentoring opportunities for our senior colleagues. In so many ways, our nation's rural communities can serve as living laboratories for social change.
As psychologists and as behavioral scientists, we should be particularly sensitive to the fact that our future is directly tied to our research and knowledge dissemination efforts. Accordingly, the associate editors of our Division's journal Psychological Services (Shelia Brandt, Leon Green, Jill Oliveira, Morgan Sammons, Gary VandenBos) and I strongly urge you to commit your experiences to print and submit an article to the journal, especially sharing relevant data. It is critically important that we communicate with each other, across programs and institutions, about the lessons we have learned in serving our public beneficiaries.
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