To Reach A Port We Must Set Sail

Possessing That Critical Global Vision:  One of the most enjoyable experiences of my approximately quarter of a century of involvement within the APA governance was having the opportunity to work closely with Bruce Overmier on the Board of Directors on behalf of all of psychology.  In May of this year, Bruce retired from the University of Minnesota after 49 years of service, a truly amazing accomplishment.  He stated, “I did not stay for the 50th year as some friends suggested; after all, 50 is just a number.”  It is fascinating to reflect upon the extent to which those elected to the APA Board come to appreciate that they must represent all facets of the field – science, education, and practice – and not merely that “special interest” which might have elected them to the Board.  Although we did not succeed, we worked diligently to bring APS back into APA by ensuring that our national association would be responsive to the unique needs of the scientific community.  Similarly, it is important for those training our next generation of clinicians to appreciate, and be responsive to, the underlying mission of the various federal agencies seeking to improve the quality of life of those subpopulations in which one is particularly interested.  For those concerned about the unique needs of our nation’s children and their families, we would suggest that the Fiscal Year 2015 Budget Justification for the Health Resources and Services Administration (HRSA), and particularly for its Maternal and Child Health program, should be of considerable interest.

The Administration’s Priorities:  The stated objective of the Maternal and Child Health block grant program is to improve the health of all mothers, children, and their families.  These legislated responsibilities reduce health disparities, improve access to health care, and improve the quality of health care.  As one of the nation’s bona fide healthcare professions, psychology must appreciate that it is our responsibility to ensure that the critical psychosocial-economic-cultural element of quality care is affirmatively included.  As the then-President of the Institute of Medicine (IOM) stated in 2006, “Dealing equally with health care for mental, substance-use, and general health conditions requires a fundamental change in how we as a society and health care system think about and respond to these problems and illnesses.  Mental and substance-use problems and illnesses should not be viewed as separate from and unrelated to overall health and general health care.”

Specifically, the Maternal and Child Health program seeks to: (1) Assure access to quality care, especially for those with low-incomes or limited availability of care; (2) reduce infant mortality; (3) provide and ensure access to comprehensive prenatal and postnatal care to women (especially low-income and at risk pregnant women); (4) increase the number of children receiving health assessments and follow-up diagnostic and treatment services; (5) provide and ensure access to preventive and primary care services for low income children as well as rehabilitative services for children with special health needs; (6) implement family-centered, community-based, systems of coordinated care for children with special health care needs; and (7) provide toll-free hotlines and assistance in applying for services to pregnant women with infants and children who are eligible for Medicaid.  Of particular interest to psychology should be the Special Projects of Regional and National Significance (SPRANS) initiative for which $77 million has been requested for the coming year.  Over the years, we have come to appreciate the vision and creativity behind this particular approach.  It was instrumental, for example, in fostering a special federal focus upon the unique and pressing needs of Native Hawaiian children and their families during the earliest stages of what has today become the Native Hawaiian Resonance.  HRSA’s budget request further notes that in an era of expanding health care coverage under the Patient Protection and Affordable Care Act (ACA), the Maternal and Child Health programs serve to assure continuity of care and to reduce coverage gaps.  It is both a safety net program and a major public health program serving mothers, infants, children (including children with special health care needs), and their families.  Perhaps most significantly for the mental health/behavioral health professions who state that, “In order for there to be measurable gains towards improving the nation’s maternal and child health, insurance coverage expansion will need to be accompanied by a significant investment in health promotion and disease prevention strategies that focus on this population.”

The Institute of Medicine (IOM):  Cognitive, affective, and behavioral disorders incur high psychological and economic costs for the young people who experience them, for their families, and for the communities in which they live, study, and will work.  This Spring, the IOM Board on Children, Youth, and Families, directed by psychologist Kimber Bogard, hosted the first workshop of its Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health.  The workshop focused on Strategies for Scaling Tested and Effective Family-Focused Preventive Interventions, featuring presentations on and discussion of successes and challenges in scaling family-focused preventive interventions; financing and infrastructure to support implementation, including how provisions of the ACA may affect programs in primary care settings; and innovative models in scaling family-focused interventions.  A perspective paper on unique opportunities and implementation barriers for family-focused interventions for children with neurodevelopmental disorders has been developed for the project’s web site.  Their second workshop focused on Harvesting Best Practices from Prevention Science to Promote Child Wellbeing.  This November, another public workshop will be convened addressing Innovations in Design and Utilization of Measurement Systems to Promote Children’s Cognitive, Affective, and Behavioral Health.  Presentations will feature the use of data linkage and integration to inform research and practice; the use of quality measures to facilitate system change in health care, classroom, and juvenile justice settings; and tools developed to measure implementation of evidence-based prevention programs at scale to support sustainable program delivery, among other topics.

Unprecedented Change Continues:  The National Center for Medical-Legal Partnership, a project of the Milken Institute School of Public Health at George Washington University has recently been awarded a three year grant from HRSA to cultivate and support medical-legal partnerships at community health centers (FQHCs) across the country.  These partnerships will bring together civil legal aid agencies and law schools with healthcare institutions to integrate legal care into the delivery of healthcare and treat individuals’ health harming social and legal needs related to housing, insurance, benefits and education.  Legal and healthcare professionals will work together to identify and improve policies and laws that affect community health.  The three year award designates the Center as a technical assistance center for health centers.  It will build relevant toolkits and provide trainings that will assist health centers to develop and sustain medical-legal partnerships.  Integrated, interdisciplinary care is a priority of the ACA.  Sail, Not Tie at Anchor.  Sail, Not Drift.


Pat DeLeon, Ph.D., J.D., is a former President of the American Psychological Association. 

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