When I first visited Hawaii in 1974, a year before I started graduate school, I was told that “aloha” meant several things:  hello, goodbye, and I love you. A few decades have come and gone since then. I finished graduate school, worked in several roles as a psychologist, and in 2008 was elected to serve as your APA Representative. As I now write my final APA Representative communiqué, I do so from the perspective of having attended my last Council of Representatives (COR) meeting in Hawaii.  It is therefore fitting that this aloha column means both hello and goodbye.  I would also have to say that as love fests go, it has truly been a blast serving you in this capacity.

In regard to COR meetings, the 2013 (COR) meeting in Waikiki wasn’t exactly a barnburner as we like to say in the Midwest.  It was important for the internal workings of APA in that it primarily focused on our Good Governance Project, a multi-year endeavor to help us become more streamlined and effective as a Council.  The work we did leading up to and being in Hawaii will reflect itself in a different composition of the Council in years to come.  I expect that you will hear more about those developments from MPA’s newly elected 2014 council representative BraVada Garrett-Akinsanya, Ph.D.

Starting the New Year

As I start the year as president of MPA for 2014, I am struck by the many opportunities for linkages and connections around us.  At MPA’s annual strategic planning meeting in the fall of 2012, participants at the meeting discussed what MPA offers to its members. The conclusion: MPA offers members the chance for connection, protection and growth through our membership and association with each other.

This committee was created by the Minnesota Legislature in the 2013 session to address needs for mental health workers across the spectrum of providers. Currently all of Minnesota except the Twin Cities and southeastern Minnesota (Mayo) are considered mental health provider shortage areas. The project is being managed by HealthForce Minnesota, the Minnesota Department of Health, and the Minnesota Department of Economic and Educational Development. The steering committee will be doing some advanced research to prepare for a summit or meeting of stakeholders that will be held on May 28, 2014 at Hennepin Technical College. The steering committee is comprised of representatives of professions, the Minnesota Department of Health, the Minnesota Department of Human Services, higher education programs specific to mental health, and private and public higher education representatives.

Several previous efforts have looked at workforce issues in mental health, including an MMHAG group in 2008, through a mental health needs assessment, and as part of the governor’s task force on health reform. The needs consistently highlighted were prescribers, especially for children and adolescents, mental health professionals that can provide supervision to mental health practitioners and those seeking licensure, culturally specific providers for underserved populations, and all providers in greater Minnesota. The primary approach to addressing shortages has been to offer tuition reimbursement and loan repayment. While there has been some use of these programs, they have not proved to be an effective tool. Additional slots have been added to the psychiatry residency program at the University of Minnesota and this has led to an increase in psychiatric providers. Efforts to ease the process of using foreign-trained psychiatrists has also been effective. Some primary care physicians have used the prescribing consultation service administered through the Department of Human Services for the care of children and adolescents to assist in providing services to this population in a primary care environment. In the 2013 legislative session, training programs in psychology and social work were added to the list of those able to access Medical Education and Research Costs (MERC) funding. Monies available for training through the Affordable Care Act do not appear to have been accessed by Minnesota training programs. It is too early to assess the impact of this extension of MERC funding.

The Minnesota e-Health Advisory Committee has been meeting for more than ten years. The committee membership is delineated in Statute, and only this year has behavioral health representation been added as an “alternate” non-voting position. MPA is honored to represent the needs and concerns of the mental health community.  The inclusion of behavioral health reflects the growing recognition of its importance in health reform. Minnesota is unique in having a mandate, passed in 2008, requiring all providers to have electronic health records by January 2015. Unlike the federal mandate, Minnesota includes behavioral health, social services, post-acute care, and public health, recognizing the need to capture a comprehensive view of patients. The e-Health Advisory Committee has worked in partnership with the Minnesota Department of Health to develop tools and standards to guide health providers in the acquisition and implementation of electronic health records. This work has been enhanced by a State Innovation Model grant awarded to Minnesota by the Centers for Medicare and Medicaid Services. Funds obtained will be used to develop and test the Minnesota Accountable Health Model. Expanding what is included in an electronic health record is an important aspect of the grant.

This year, Minnesota’s e-Health Advisory Committee made the decision to focus on three particular areas regarding the electronic exchange of health information. Three work groups were formed including Health Information Exchange Oversight, Standards and Interoperability, and Privacy and Security.

MPA has long participated in the Mental Health Legislative Network (MHLN). It is a group of thirty provider and advocacy organizations that support each other’s work, and legislatively address issues related to mental health. The purpose of the group is to advance the understanding of and services to people with mental illness. The view is that as a group more impact can be had. It is the group that organizes Mental Health Day at the capitol each year. Often representatives from the Department of Human Services are in attendance, and occasionally legislators will attend. The MHLN meets weekly when the Minnesota Legislature is in session, and monthly when not in session. It is hosted by either the Mental Health America-Minnesota or NAMI-MN organizations. Their support includes testifying for one another’s bills when needed, as long as they fit with the members’ viewpoint. The MHLN does occasionally act as a unit to write letters of common concern to the Commissioner of the Department of Human Services, payer organizations, the Governor, legislators, and members of Congress.

Participation in the MHLN has been a great support for MPA. They have joined with us on concerns with payers in the past, testified for our bills, and generally provided a greater probability of bill passage. They were especially helpful in dealing with legislation that sought to allow physician assistants to be paid as mental health professionals.

The Electronic Health Records (EHR) Task Force has accomplished a number of activities. The Task Force researched EHR, made a presentation for the MPA Annual Convention, met with some EHR vendors, met with representatives from the Department of Health and Stratis Health, met with a multidisciplinary group of mental health providers interested in EHR, and discussed the development of a toolkit for behavioral health to assist providers in choosing the best EHR for their practices.

Plans for the coming year include coordinating trainings in how to use the toolkit, reviewing the possibility of developing a Health Information Exchange mechanism specifically for mental health that could provide additional safeguards for our patients, developing a vendor fair for members, and presentations at the MPA Annual Convention and Minnesota’s 10th Annual e-Health Summit.

The highlight for MPA of the 2013 Minnesota legislative session was the passage of our bill to allow psychologists to be reimbursed for consultation to primary care. Senator Julie Rosen shepherded the bill through the legislative process. A number of measures improving mental health services passed, in response to the tragic events at Sandy Hook Elementary. Examples included the extension of coverage for waivered services to individuals with a diagnosis of schizoaffective disorder and increased technical assistance to provide in-school mental health services. Gun control legislation was a major focus at the legislature, though no changes ultimately occurred.

For the 2014 session, MPA will work on having psychologists listed as a profession that can direct a health care home. This will be important when behavioral health homes come into fruition. Behavioral health homes provide primary care services to individuals with serious mental illness in settings where they are most comfortable obtaining care. Recent research demonstrated that individuals with serious and persistent mental illness die on average 25 years sooner than their same age peers. Behavioral health homes are an effort to fill this gap and ensure that people with mental illness receive comprehensive care. Other organizations will be working on some changes to the commitment statutes and adding services to engage individuals in treatment who do not meet commitment criteria, are not necessarily in a crisis, but do need to develop a relationship with providers to engage in treatment.

Starting January 1, 2014, all Americans must have health insurance, with very few limited exceptions. To help make insurance affordable, tax credits are available and in Minnesota Medical Assistance was expanded to include low income adults. Many people with mental illnesses faced barriers to accessing insurance due to a pre-existing condition, no coverage for mental health treatment, high deductibles or not meeting disability criteria for Medical Assistance.

NAMI Minnesota recently received a grant to provide outreach and assistance to people with mental illnesses and their families to access insurance through Minnesota’s health care exchange MNsure. NAMI Minnesota is collaborating with mental health providers to ensure statewide outreach.

Nominations for each of three MPA Teaching Awards (Graduate Faculty in Psychology, Mink Outstanding Undergraduate Teacher Award, Outstanding Teaching of Psychology in Community/Two-Year Colleges) should be submitted to the MPA Office no later than Friday, February 28, 2014.  The criteria and nomination process for each award are outlined below.  Questions can be directed to Jack Rossmann at Macalester College ([email protected]).

MPA Award for Outstanding Graduate Faculty in Psychology

The Minnesota Psychological Association is seeking nominations for the MPA Award for Outstanding Graduate Faculty in Psychology. This award recognizes a faculty member who brings a special quality or commitment to working with graduate students in psychology. The award will be presented at the MPA Annual Convention. The procedures and criteria for the award are outlined below.

1)      What is your background in psychology (e.g., education)?

I started my education with a BS in Psychology and continued directly on from there to complete a teacher competency.  I gained licensures in Learning Disabilities and Emotional Behavioral disorders, finishing up with a MS in Special Education.  In 2005, I graduated with a MS in Counselor Education, completed 4,000 supervised hours, and currently I am a Licensed Professional Clinical Counselor.

Though Minnesota’s Legislature does not convene again for several months, a number of projects are underway. If you have any interest in participating in the projects, please contact the MPA office at [email protected] or 952-564-3048.

Participation in the State Innovation Model (SIM)

The University of Saint Thomas Psychology Graduate Student Organization of the College of Education, Leadership and Counseling hosted Dr. Kay Slama, Ph.D., MSS, L.P., for a presentation regarding the principles of rural culture and rural counseling competencies on Thursday, October 17. Graduate students from around the Twin Cities were able to attend the free session designed to increase awareness among urban and suburban psychology students about the needs and opportunities in the greater Minnesota region. Opportunities to obtain graduate school loan forgiveness through the National Health Service Corps program was also discussed.

Dr. Slama described rural Minnesota as existing on a continuum, from a person or family who lives and works on a farm to individuals who live and work in small towns. For individuals and families who live on farms, the impact of their vocation cannot be overstated. Dr. Slama described farming as intensive work that occurs seven days a week and is often accompanied by a sense of duty to the family’s prior generations.

Behavioral health professionals from several states joined MPA’s Rural and Greater MN Division (RGMD) October 11 for their fifth annual conference, focusing on “Advances in Rural Behavioral Health.”  Evaluations showed high satisfaction with conference content and format.  Dr. Willie Garrett, RGMD Chair and Conference Co-Chair, commented, “Rural professionals were offered an inexpensive ‘blueprint’ for success, in preparation for the new era of rural psychology practice and healthcare reform.”

Partnering with the Illinois Psychological Association was a successful experiment this year.  IPA contributed three committee members and pulled in nearly 30% of the participants.  Other partners included the Psychology Discipline at UM-Morris, the Western Interstate Commission on Higher Education, and APA’s Committee on Rural Health.

This is my last President’s Letter, and like the President before me, I am feeling grateful and thankful. I came into this year with a goal to establish stability through increased accountability and transparency in MPA. Major projects to this end included:

• Updating the Policies and Procedures (especially those related to leadership and finances) and making these widely available.
• Clarifying decision-making processes and the roles of the Governing Council and Executive Committee.
• Creating two additional committee structures endowed with the ability to improve both accountability and transparency for MPA leaders and staff.  These include the Financial Consultation Committee chaired by Bruce Bobbitt responsible for internal annual reviews of financial transactions and the Leadership Development and Nominating Committee chaired by the Immediate Past President responsible for recruiting volunteers in MPA and orienting leaders to what is required of them.

This has been a productive year, and I want to say thank you to all of the people who helped to make my presidency a fruitful and harmonious one. Special thanks to those with whom I worked particularly closely: Secretary Mera Kachgal, 2013 Annual Convention Committee Chair Kate Jalma, Annual Convention Committee Member Tom Skovholt, and Public Education Coordinator Jenna Bemis. I would also like to say thank you to Dan Christensen who was a wonderful Past-President: supportive, reliable, good-humored, and grounded. And, I would like to recognize and thank Rhea Sullivan our Administrative Director who joined us in March and made all the difference for MPA — helping us attain fiscal solvency and a high level of customer service.

As I have mentioned in previous columns, MPA’s strategic planning sessions in September of 2012 identified “Connection, Protection and Growth” as the overarching concepts under which MPA brings value to its members.   This year’s strategic planning meeting in October reviewed the progress that has been made during the past year, under the outstanding leadership of our president, Tabitha Grier-Reed, Ph.D., L.P., on specific steps that have been taken to make sure that MPA has the structure and operations to provide connection, protection and growth.  The October planning meeting also reaffirmed these overarching concepts—one might even call them ideals.

New Evidence Just In

The Patient Protection and Affordable Care Act (ACA) is the most important piece of health care legislation at least since the founding of Medicare and Medicaid in the 1960s, and may prove even more important than that.  Reactions among psychologists to the process that the ACA has instigated vary between dumbfounded anxiety, extreme skepticism, and cautious optimism.  Whatever your opinion of those changes, there are some questions to which you need the answers.  This article is our best effort at giving you answers to those questions.  Far more change is in the works than has occurred already, so read this article knowing that some of these answers will inevitably be outdated in the near future.

Thirty years ago I was told I was doomed if I didn’t join managed care.  I decided against it and the apocalypse never happened.  Isn’t this fear about health care reform just more of the same hysteria?  

As your representative who sits on the Advisory Board of Health Professionals Services Program (HPSP), it is time again for me to give a little information about this valuable but little known program. It provides monitoring services to health professionals with illnesses that may impact their ability to practice. HPSP promotes public safety in health care by implementing monitoring plans that are related to appropriate illness management and patient safety. A plan may include the participant’s agreement to comply with continuing care recommendations, practice restrictions, random drug screening, and support group participation.

The functions of HPSP include:

Having the 121st Annual APA Convention in Honolulu, Hawaii was extraordinarily memorable for the 11,400 registrants and HPA.  The vision, vitality, and enthusiasm of the next generation were infectious.  From a health policy perspective, it was especially gratifying to see the extent to which new career psychologists and graduate students were actively embracing the notion of integrated, patient-centered care which is the hallmark of President Obama’s landmark Patient Protection and Affordable Care Act (ACA).  Unprecedented change, driven primarily by historically escalating costs and a new appreciation for the potential contribution of the advances occurring in communications technology (i.e., electronic health records, comparative effectiveness research, and telehealth), is rapidly impacting the nation’s healthcare environment.  Cynthia Belar described how from the APA Education Directorate’s vantage point, psychology’s training institutions and internship sites are successfully adapting to the changing demands of the 21st century.  Personally, one of the most gratifying presentations at the convention was the symposium chaired by Patti Johnson, who has now served in the U.S. Army for over 20 years, addressing the unique psycho-social needs of military families and especially their children.  The nation’s protracted conflicts have had a significant impact upon the behavioral health of military children and youth.  Patti’s panel discussed a number of innovative programs that were making a real difference.  All of psychology owes President Don Bersoff our gratitude for his vision and passion in developing special Presidential programmatic initiatives focusing upon how psychology can contribute to the nation’s responsibility for our Wounded Warriors and their families.

I currently have the opportunity of serving at the Uniformed Services University of the Health Sciences (USUHS) (DoD) where psychology and nursing have made a special, and in my judgment visionary, commitment to fostering true interdisciplinary training.  “As a graduate student in the clinical psychology doctoral program at USUHS, I study alongside advanced nursing students.  Participating in interdisciplinary classes has taught me that psychology and nursing share similar goals and pursue complementary research questions.  When looking for allies to improve the health care of our warriors and our nation, nurses and psychologists have to look no further than to each other.  And, by collaborating in our formative years, we maximize our impact as team-based healthcare providers (Joanna Sells).”

1)      What is your background in psychology (e.g., education)?

I received a bachelor’s degree from Middlebury College (Vermont) with a major in psychology. I then completed a master’s degree from the counseling and student personnel psychology program at the University of Minnesota. I am currently working on my doctoral degree in counseling psychology at the University of Iowa.

Strategic Updates

I am now entering the last quarter of my Presidency, and am happy to share with you the strategic accomplishments MPA has achieved this year. The objectives for 2013 included identifying gaps and strategies to strengthen four major areas: organization structure and operations; fiscal solvency; leadership and governance; and, member engagement. First, let me tell you that at this point MPA is financially solvent.  In addition, the 2013 Governing Council has worked to review and approve policies to secure the foundation for financial stability and organizational health into the future in all four major areas of MPA. For example, with respect to leadership and governance, the organization has instituted board training for each Governing Council as well as clear documentation of Governing Council Members’ Duties and Responsibilities. Similar documents have been developed and approved for MPA Division Chairs and Committee/Task Force Chairs. Moreover, to increase oversight, MPA has passed a Whistle Blower Policy as well as an Annual Audit Policy. We have also updated our Travel, Reimbursement and Expenditure Requests policies and forms. Finally, we have increased our membership to close to 700 members, and we are focused on continuing to work toward the protection, connection, and growth of psychologists.

Connection, Protection, and Growth

MPA exists for the protection, connection, and growth of psychologists, and we need you to effectively serve this function. Many of you may be aware of changes occurring within Blue Cross/Blue Shield (BCBS) who recently implemented a drastic fee reduction affecting psychologists and switched to the Mihalik Group’s Medical Necessity Review Criteria for Behavioral Health. As a result psychologists have complained about difficulty getting access to the manual.