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American Psychological Association
Committee for the Advancement of Professional Practice Liaison/Consultation
Group Meeting
Los Angeles, California
August 15, 1994
Process Notes
Attendees: Eric Harris, Dan Eubanks (Division 40), Jean Carter (Executive Roundtable of Practice Divisions/Division 17), James Barron (Division 39), Sandra Harris (CPA), Marilyn Metzl (Missouri), Marc Ackerman (Wisconsin, President), Sarah Bowen (Wisconsin), Carolina Yahne (New Mexico/SLOC), Mark Ciocca (New Hampshire), James Bray (Division 43/SLOC), Steve Peltier (SLOC/Minnesota), C. Gerald O'Brien (Division 3l/Mississippi), Sheila Schuster (Kentucky,Executive Director), Michael Roberts (SLOC/Mississippi), George Taylor (CAPP), Ron Levant (CAPP), Ruth Paige (CAPP), Elena Eisman (CAPP), Stuart Koman (CAPP), Kathy Peres (CAPP), Steve DeMers (CAPP), Ron E. Fox (APA President), Eden Deutsch (Washington, President), Rod Baker (Division 18), Laura Toomey (Division 12/Connecticut),Dorothy Cantor (APA President-Elect), Pat Bricklin (CAPP), Lee Hersch (Virginia/Division 42), Bruce Bobbitt (C/R-Minnesota), Jerry Morris (C/R-Missouri/Division 42), Neil Massoth (C/R-New Jersey), Harriette Kaley (Division 39, President-Elect), Stanley Moldawsky (Federal Coordinator-New Jersey/C/R-Division 42), Karen Shore (Divisions 42 and 39/N.Y./Coalition of Mental Health Prof.), Ray Mount (Consortium for Psychotherapy, Boston), Norine Johnson (Division 35, President), Daun H. Martin (California, President/Divisions 42 and 31 (SLOC)), Stephen Pfeiffer (AAP Board/Director), Louise Holt (Division 42, President-Elect), James L. Poulton (Utah, President), Ellen Caringer (Hawaii, President), Stan Lunde (Division 33), Dan McKitrick (Oregon), Carl London (CPA), Penny Warren (P.D. Staff), Chris Barrett (P.D. Staff), Billie Hinnefeld (P.D. Staff), Shirley Higuchi (P.D. Staff), Chris Vein (P.D. Staff), Michael Su11ivan (P.D. Staff), Russ Newman (P.D. Staff), Neela Agarwalla (P.D. Staff), Cindy Yeast (P.D. Staff), Henry Engleka (P.D. Staff), Randy Phelps (P.D. Staff), Mary Enerson (P.D. Staff)
Levant
{Introductions were done.) This is the second meeting specifically intended to address concerns and issues expressed by various members and practice constituency groups. CAPP expanded the 1993 retreat to include divisions and CAPP invited more diverse groups to attend the Liaison/Consultation Group meeting this year. The changes in the health care market are effecting changes at the state
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level and affect how practitioners practice, and are polarizing the community.One of the goals for the meeting is to bring different viewpoints to the meeting and to move forward together. This is the only way to survive.
The three-prong approach from the Practice Directorate is: (1) Legislative/Advocacy; (2) Legal/Advocacy; (3) Positioning of psychologists to compete more effectively in the changing health care market.
Newman
In order to clarify misperceptions and concerns regarding the activities of the Practice Directorate, it is important to distinguish between goals and strategies. The goal of the Directorate is to protect and expand the range of psychological services available to the public, irrespective of setting. The Practice Directorate has been working this agenda in using different strategies that complement one another as follows:
(1) In the legislative area at the state and federal levels, to make managed care as regulated and accountable as possible, and to position psychology favorably in National and State Health Reform.
(2) In the legal affairs area, to monitor, support, and develop litigation, such as those in Virginia and Massachusetts which work to remedy overaggressive and inappropriate cost containment strategies.
(3) In marketp ace 1 initiatives, the newest piece, to work within the market, business and corporate realms to try to position psychology better and to enhance how services are being provided. This is more complex and there is a need to educate individuals. Some have been confused that strategy #3 had replaced #l and #2 as priorities. Additionally, some have viewed strategy #3 as indicative of a goal to simply join forces with the corporate healthcare community rather than as yet another way to maximize our ability to define the psychological services being offered.
Koman
A focus of CAPP's agenda relates to the business/marketplace in two specific areas: (1) How to provide concrete, immediate assistance to psychologists. A book entitled Business Strategies for a Caring Profession,” has been produced to help practitioners bring along their practices. In conjunction with the focus on the Practice Miniconvention, Coping With the Business and Corporate Practice of Health Care,” the book makes a strong statement and can be very
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helpful in improving psychologists' business skills. (2) A more delicate area is the outcomes manual. Because we are psychologists, it makes it difficult and at the same time, because we are psychologists, it makes it more important. CAPP is working with different constituencies to collaborate in order that they (psychologists) may have a greater say.
Eisman
It is important to know that CAPP took the feedback from the retreat seriously and wants to imbed the work of CAPP within the context of other work at APA.CAPP is working with ODEER and the Practice Divisions to develop a survey of special assessment payors and determine the impact of managed care on the type of work that psychologists are doing. CAPP would like to take a snapshot” of the special assessment payors through this survey. CAPP is also developing a Manual on Outcomes Research for Practitioner Use” that will offer an overview of this area. CAPP will be working with divisions as to what is important to look at and ask divisions for any information that they may have from their members. CAPP has also been involved with the initiatives of the Task Force on Psychological Intervention Guidelines and the concept of a practice research network in conjunction with BPA.
Cantor
The ODEER survey needs to be done frequently. Every division wants to define themselves as a practice division and we need to see what divisions pay, how much, etc.
??
Pat Bricklin and Steve DeMers are members of the Schools as Health Service Delivery Sites Work Group. The work group is pulling together a written piece looking at ways of how psychological services are delivered in the school system and how to partner with the school community. They plan to have a product to CAPP for review at their October retreat.
Taylor
The College is well underway and is leaving the training outside of the College which allows an opportunity for states to augment their CE programs.
Moldawsky
The new Accreditation document is out to the field with a six month window to respond. The committee tried to make the document more practice friendly, i.e., include as many specifics as to how to train a practitioner as possible. They worked out a lot of compromises and CAPP needs to look at it and respond. It was noted that when trainers and practitioners discuss issues there is general agreement, but problems occur when you begin to write documents.
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Levant
Dave Barlow, Chair, Task Force on Psychological Intervention Guidelines, met with CAPP at their July meeting and heard the concerns voiced on behalf of the practitioner community about their draft template. There is greater and better dialogue taking place between practice, science and education. There is a continued need for more and better dialogue within the practice community.
Moldawsky
Only 14 independent practitioners responded to Division 42's request for interest in participating in accreditation site visits.
Mount
With regard to the outcomes manual and a need to prove our work is effective, we need to be concerned about the implications and effect on patient privacy.
Eisman
The outcomes project research is not interested in specific individuals. We are more interested in driving the measures used to determine outcomes measures in a way most appropriate to psychological practice. Previously, most measures had been developed in medical settings. There is recognition that the research has to be done carefully and sensitively.
Hersch
Division 42 has accepted its Emerging Patterns of Practice Committee report. The Division would like specifics such as a good primer on how to do business, more detailed practical guidelines, a template for standardization for outcome measurements with computer systems, templates and specific recommendations for practice research networks and financial assistance to get people on an e-mail system.
Yahne
Some psychologists have expressed concern regarding Insurance Trust issues.
Morris
CAPP has been doing good work, the addition of Stu Koman is right on target and the miniconvention is reflective of CAPP and the Practice Directorate leading the way. Two areas need to be kept on the radar screen. The first is how to go to hospitals and present brief, comprehensive data to CEOs. Within integrated care, hospitals are still very important. Second is a most pressing legislative problem. State Medicaid reforms are leading to takeovers of market shares by CMHC's. It is how reform is playing out within the states.
Shore
With regard to guidelines, it would be very important to include a psychoanalytic/psychodynamic perspective since there are feelings of being left out. Keep this in mind for the outcomes study. Maybe the
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point will be missed if you focus on diagnosis and fall into the medical mode.
Eisman
Nowhere was it stated that the outcomes would be tied to diagnosis. The divisions will be surveyed for input. As to the most appropriate criterion measures, that is where you need to input this point. This is a pilot endeavor. The survey will look at special assessment payors and how their work has been affected.
Newman
We would ask that the divisions designate a point person for us to work with in order to better integrate and facilitate the flow of information.
Shore
There is a need for full recognition that there are those in managed care that maybe do not want to be there. It would be helpful to solicit this information in the survey.
Cantor
The most recent ODEER survey of graduate students indicate that they have a very bleak outlook.
Shore
More support is required for clinicians who think that it is wrong to work for managed care companies and can not feel good about working in managed care settings. There is a need for free choice.
Levant
CAPP and the Practice Directorate have always supported an opt out” plan for psychologists with any system that gets enacted. It should be noted that CAPP often has observers from Division 39 (Nate Stockhamer and most recently, Harriette Kaley) at CAPP meetings. With regard to the composition of the Task Force on Guidelines, practice had a limited number of seats on the eight member task force and a balance had to be struck between BPA, CAPP and BSA.
Martin
There is a need for more support for VA psychologists. More and more psychologists need to be encouraged to work with the public sector clients because of medicaid/medical changes. There needs to be guidelines for psychologists in public settings.
Baker
It would be helpful and supportive to identify public sector psychologists as real practitioners and to find a role for VA psychologists. The dialogue with CAPP has come a long way.
Taylor
The thrust of the initiatives is not toabandon any group but to have muscle to influence. Without muscle in the system, we will be left
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out. Within CAPP, there are limited resources.
Shore
It is important to know that managed care is thinning our ranks and there is concern that we will not have the money to fight.For example, 200 out of 500 psychologists did not renew memberships with the Houston Psychological Association.
Bray
That's not accurate.
Phelps
The situation with the Houston Psychological Association is that the renewal letters went out late and therefore, there was a delay in response from the membership.
Johnson
CAPP has a history of focusing us and leading the way. What CAPP and the Practice Directorate have been doing is a leading us in a healing process. Outcomes in parenting/children issues is an area that needs to be looked into.
Bray
Reimbursement for family/marital therapy needs to be looked at by CAPP. Also Medical colleagues have been doing outcomes measurements via practice research networks for a long time with federal funding. The Rural Task Force is looking into this. There is also a need to look at mental health care and how it relates to primary care.
Eubanks
There is a need to focus on reimbursement problems with regard to assessment. When a PhD does an assessment in some medical offices, it is not reimbursable. Division 40 can assist CAPP and the Practice Directorate.
Peltier
State Health Reform is important, and CAPP needs to look at how ERISA comes into play. There is a need to develop health care management skills to better manage care. Keep in mind that timing for state associations may be different than elsewhere, i.e. short term is 3 - 6 months and long term is l-2 years. We need to further link division and state practitioners and to unify efforts to push forward the agenda.
Kaley
CAPP has been very responsive. The services of division 39's research section are available to help out.
Paige
CAPP is looking at managed care abuses and regulation. Some managed care companies are offering coverage for couples. Many private practitioners are now dealing with the issues that the public
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sector has been dealing with for years in reporting to nonpsychologists.CAPP is very mindful of the grieving psychologists are undergoing.
DeMers
School psychologists can help in this process. They have expertise in dealing with dilemmas of working for nonpsychologists. Educational reform is going on and creating greater opportunities. Schools could be a new marketplace. Also keep in mind that some psychologists are being brought before the licensing board for misdiagnosis as it relates to family therapy and the reimbursement issue.
Metzl
Everyone is in a state of depression and feeling that there is no one there to answer questions.We need some sort of clearinghouse with a toll free number.
Engleka
The Practice Directorate has a toll free number and there is a managed care office within the Directorate that deals exclusively with issues and problems related to managed care.
Cantor
We need to look at a non-medical based diagnostic system.
Levant
CAPP is looking at this issue. We are out of time, but I do want to thank everyone for their participation and suggestions.
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