“IF YOU WAKE UP AND DON’T WANT TO SMILE. OPEN YOUR EYES AND LOOK AT THE DAY”
A Vision of the Future: Barbara Van Dahlen and her spouse Randy Phelps have built a tech company (WeBeLife.com) and launched a free App to improve emotional health and well-being. Their WeBe App teaches users and family members about evidence-based elements that affect their well-being to help them better care for themselves and their loved ones. The App provides a simple mechanism that takes 1-2 minutes daily for users to track six factors affecting their well-being: relationships, emotional experience, spirituality, physical health, activity, and sleep. Each of these elements is modifiable through the user’s behavior, a critical requirement for the user’s success using the WeBe platform. The evidence base across these combined elements is voluminous, with each having a well-established track record demonstrating its impact on well-being.
The WeBe model also capitalizes on the powerful effects of social support on mental and physical health. The effects of social support on mental health are well known, with an evidence base that extends over well more than 40 years. WeBe increases social support by allowing the user to create a “pod” – a safe and private online space for users to share their personal ratings and well-being information within a small, select group of one to four hand-selected trusted individuals. Pod members also track and share their ratings as well within the pod, which serves as a private support group for all.
Their WeBe App also promotes well-being and supportive communications through messaging channels with user-controlled privacy settings, closed affinity groups for sharing well-being information with like-minded individuals, and a broader communications channel for fostering community well-being.
The hope is the WeBe will help individuals and their loved ones harness the positive power of social connection, improve their overall well-being, identify those in need of additional support, and direct those who may be struggling to appropriate care and resources. In 2008, Randy served as Interim Executive Director hosting the 25th APA Practice Organization State Leadership Conference Leading Change: Advocating for Psychology Practice. Those present will warmly recall David Ballard’s most impressive third annual Psychologically Healthy Workplace Awards ceremony, where psychology has made a real difference over the years.
Interprofessional Education (IPE): One of the hallmarks of the Uniformed Services University (USU) is the active engagement of faculty and students in Interprofessional Education. For integrated care to effectively exist, it is important that the health professions expose their students, early on in their training, to the contributions, language, and culture of the other professions. Psychology faculty Abby Diehl: “The singular truth of the universe can be encompassed in two words: ‘everything changes.’ As an educator, I insist on designing experiences to develop critical thinking and innovation skills for learners in my courses. An inter-professional medical educational environment is key. Learners are able to take diverse perspectives and work as a team as they prepare for a simulated behavioral health military exercise (e.g., Bushmaster). Collaboration experiences are both crafted and modeled. For the behavioral health military education at USU, I work with the School of Medicine and Graduate School of Nursing faculty to achieve together what we cannot do alone. The future of behavioral health training is now and it is happening at USU. In a constantly changing global environment, what other choice do we have but to both model and train creative collaboration?”
Brent Donmoyer, Psychiatric Nursing faculty: “It all began with To Err is Human: Building a Safer Health System (IOM, 1999) and continues today through the Agency for Healthcare Research and Quality (AHRQ) and their focus on building High Reliability Organizations (HROs), with strong leadership focused on safety, building teams across specialties, and improving communication between these professionals. In the U.S. Military there is a saying ‘train as you fight,’ for medical professionals ‘train as you practice.’ Inter-Professional Education (IPE) should be the standard, not the exception. At USU, where nursing and psychology are just across the quadrangle, we are constantly looking for ways to improve or increase IPE learning opportunities, one being the hallmark event, the Bushmaster Practicum; simulated medical training, with live simulated patients in an austere setting. This exciting event has been occurring for decades, one of the more recent additions has been the Behavioral Health element (BH@BM), an IPE learning experience for students of the Psychiatric Mental Health Nurse Practitioner program and Clinical Psychology program. [ https://usupulse.blogspot.com/2018/10/bushmaster-prepares-mental-health.html ]. The IPE nature of this practicum/training is essential to the development of military mental health providers, team members in a complex unique population where collaboration is key to patient care and safety. It should be essential and the standard for all medical education!”
The Critical Importance of Unanticipated Opportunities: Hawaii — Ray Folen, HPA Executive Director: “During the Little League World Series this August, the ESPN announcers frequently attributed the Honolulu team’s outstanding performance to a philosophy the team embraced throughout the season. On the back of the team jersey, in lieu of the player’s name, was the simple formula ‘WE>ME’. It was this focus on collaboration and teamwork that the coach believes was key to the team’s world title win.
“Taking a lesson from these 12-year-olds, HPA has engaged collaboratively with a number of health care stakeholders, to include allied health care professions and organizations like the Hawai’i chapters of Mental Health America, AARP, National Association of Social Workers, the Hawai’i Primary Care Association, Hawaii Nurses’ Association, Association for Marriage and Family Therapy, Parkinson’s Association, and the State Council on Mental Health. The value of this effort became abundantly clear during the 2022 legislative session.
“The philosophy embraced by the Little Leaguers tends not to find its way into state and national legislatures, unfortunately. As one of the primary initiatives for 2022, our coalition introduced legislation to add telephone-based mental health services into the definition of ‘telehealth’. The intent of the bill was to improve access for care for those who did not have the bandwidth, funds, skills or capacity to effectively utilize video-based technologies. This included patients located in rural areas, the poor, the elderly and those with physical limitations. The bill received overwhelming support from health care providers and the community at large. The only opposition came from the insurance companies. Given the tremendous community support for the bill, a key legislator found himself in a difficult position – either provoke the ire of the community or that of the insurance companies.
“The legislator ultimately embarked on the strategy of introducing another ‘supportive’ bill embedded with ‘poison pills’ that effectively produced a result directly opposite that of the original bill’s intent. It allowed phone-based telehealth only in areas that did not offer the needed internet bandwidth. Thus, the elderly patient who lacked the technical skills to get a video conference going would not be covered for phone-only services if they theoretically had access to the bandwidth. The bill would also require face-to-face contact prior to telephone-only authorization, which effectively precluded Honolulu therapists from providing needed services to patients living on the neighbor islands. The bill also specifically excluded phone-only services from the definition of ‘telehealth’, in direct contrast to the original bill. To say that the Hawai’i community was appalled by these changes would be an understatement. At the same time, the architect of these changes continued to promote the revised bill as ‘an improvement to access to care’. Those statements were sufficient to get the legislation passed through both legislative bodies. As one legislator subsequently told us, their breath and depth in understanding all the bills going through the legislature is ‘a mile wide and an inch deep’ and this allowed the ‘poison pill’ to pass through the legislature primarily on the positive spin it was given.
“In response to this turn of events, our coalition came together as one voice to denounce the revised bill that was now on the Governor’s desk. A press conference was held at the State Capitol; op-eds and letters to the editor were published; the Governor, Lieutenant Governor, and all of the State health-related Departments received constant communications from stakeholders in the community. In the same legislative session, a bill passed that authorized veterinarians to provide phone-only services. Our organizations’ members contacted their legislators to ask for telehealth access equivalent to what their pets were receiving.
“One of the most persuasive and influential statements came in the form of an op-ed from the Hawai’i Chapter of AARP, which represents a vast number of retired and elderly community members. The editorial department of the major Hawai’i newspaper subsequently weighed in with an editorial opposing the bill. These collective efforts resulted in the Governor’s veto of the bill!
“Had we not already formed these close relationships, we would not have won this battle and access to care would have suffered a major setback in our State. The coalition we have established is now set to re-introduce the appropriate telephone telehealth bills at the start of the 2023 legislative session in January. Yes, there are differences in the way our organizations view health care and, so far, having a positive collaborative foundation has helped facilitate the resolution or accommodation of those differences. ‘WE>ME’.”
Montana: During the 2007 APA State Leadership Conference, Michael Butz and George Watson presented on the Montana Psychological Association RxP experiences. (Highlights) “While the Montana Psychological Association (MPA) has had a focus on the issue of prescription privileges for licensed psychologists for some time, coming into the 2007 Legislative Session the association did not feel fully prepared to take on this issue. But, on January 2nd of this year, Senator Dan Weinberg introduced a draft bill. We were taken entirely by surprise. MPA’s leadership quickly went to work to catch up with what is generally felt to be an opportunity, but an opportunity that we may not have been well prepared to capitalize on at this point in time. Our Executive Director Marti Wangen polled our membership: 88.9% Accepted psychopharmacology as a recognized proficiency area for properly trained psychologists; 90.5% Favored properly trained Montana Psychologists obtaining prescriptive authority; No respondent to the survey indicated that they would ‘actively work against legislation.’
“MPA leadership had another conference call with APA’s Deborah Baker and Dan Abrahamson wherein it was agreed to complete the application for emergency funds via the CAPP Grant process. February 7th, MPA chose to fully pursue this matter. Ultimately. MPA decided to support this bill in light of the very reason it was introduced; to assist in stemming the tide of the behavioral healthcare crisis in Montana. We were aware that in 1995, some licensed psychologists attempted a bill in Montana which failed to emerge from the Committee Hearing on a 9 to 6 vote. Since that time no attempts had been made in this direction. We knew that it would be stated by those opposed that psychologists did not possess the medical training required to safely prescribe. Senator Weinberg brought our Association’s leadership together with Psychiatry’s leadership. There were the expected objections. They simply objected to the bill on the basis of patient safety. What was most troubling to me in this exchange, as a scientist-practitioner, was that they had not read the current bill and they had not made an effort to obtain information on the recommended training psychologists receive.
“At our hearing George Watson spoke to the Board of Psychology’s rationale for support. Elaine LeVine spoke authoritatively to the challenges in New Mexico and that they now have prescribing psychologists in many areas of the state, to the safety of the prescribers and the training that they receive. But, when all was said and done at roughly 5 p.m. on the 27th, fear won the day, as several Senators called this bill an experiment, continued to say it was unsafe despite the data, etc. Even so, the Bill lost on only a 20 in favor, to 30 opposed vote. MPA exceeded all of its markers for success. Parenthetically, as may be deduced. The bill did make it out of Committee, and was debated in the Senate after MPA had less than two months to work on this legislation.
“Three lessons learned were: * Work to support behavioral healthcare in your community and your state, and you will be supported in turn. * Be motivated to consider prescription privileges by the need, and persuaded by the safety involved when appropriate trained psychologists prescribe. And, * Opponents to these bills have an advantage, as creating fear only takes a moment. Creating understanding, however, requires time, education, and dialogue. MPA is proud of its effort, its leadership and members; and is thankful to all those who supported this effort.” “You’ll see things in a different way…. Don’t you look back” (Don’t Stop, Fleetwood Mac). Aloha,
Pat DeLeon, former APA President – Division 55 – October, 2022