xxAACP Newsletter, Volume 18, Number 1, Winter/Spring 2004
The AACP fall Board meeting was held in Boston October 29-30, 2003, prior to the IPS meeting amidst historical landmarks and Haloween-costumed AACP revelers...
Treasurer’s Report
Dr. McQuistion reviewed the updated AACP budget summary. For the first time, the budget summary included a Global Statement on Profit and Loss. Dr. McQuistion reviewed income and expense trends in detail. Dues income is virtually unchanged compared with 2002. He reported that LOCUS income is several thousand dollars ahead of projections. Unexpected income of approximately $5000 will be received from the 2003 Winter Meeting surplus. In addition, an unrestricted corporate donation of $20,000 is anticipated. Travel reimbursement is $3,159.80 over budget (although partially offset by Board member travel contributions for 5/03 meeting). Dr. McQuistion advised that this expense item bears watching. By Board Action, travel reimbursements have been halved starting with this meeting. In summary, Dr. McQuistion observed that AACP remains solvent, and that its financial status was improving due to savings initiatives, contributions and increased LOCUS income.
Guests and Networking
Steve Sharfstein MD, APA Vice President, presented to the Board his candidacy for APA President. Observing that he has worked in community psychiatry for most of his career, he stated that the major focus of his presidency would be access to care. Specific concerns he wants APA to address are mental health parity, insurance business practices that infringe on confidentiality, Medicare and Medicaid cuts, and community psychiatrist shortages. He also expressed his desire to become more involved in Washington politics and mental health parity.
Jay Scully MD, APA Medical Director, reported on current APA activities. “We are trying to reconnect with our mission 1) improving care of our patients, 2) supporting research and education, 3) member care, and 4) working with advocacy colleagues to help save what’s left of Medicaid.” He reported that the APA budget is now “significantly in the black” due to several interventions including many calls to lapsing members, outreach to training programs. Membership losses have stopped, and dues income now exceeds projections. Advance registrations for the October IPS meeting had already broken records.
Dr. Pollack requested assistance to reverse the recent rejection of AACP/NASMHPD’s official symposium submission (on the Medicaid crisis) for the 2004 annual meeting. Dr. Scully noted that, unfortunately, many submissions were rejected due to space limitations. However, he understood the importance of this presentation, and agreed to work on its reinstatement.
Jim Nininger MD, Speaker Elect of the APA Assembly, Prakash Desai MD, Speaker of the Assembly, Nada Stotland MD, Past Speaker of the Assembly, and Marcia GoinMD, APA President reported to the Board on APA Assembly/other leadership initiatives. Dr Nininger reported that the next Assembly meeting will focus entirely on a single theme—access to care. Gaven Andrews from Australia will address global burden of disease; Altha Stewart will speak on health care disparities;Paul Appelbaum will report on actualization of the vision document of the APA; Dr. Nininger will present a forum on jails and prisons; and DPO will present on disaster preparedness.
Dr. Stotland encouraged AACP to continue its pressure on the APA to address its priority public mental health issues. Members can address communications to APA’s Margaret Duer for dissemination to the APA Board of Trustees, the Assembly, and to other APA leaders.
Dr. Goin confirmed her commitment to addressing Medicaid cuts. Addressing AACP Board concerns about the rejection of its symposium on this topic for the 2004 Annual Meeting, an extended discussion followed examining the program selection process.
Liz Kramer, of Overcoming Stigma in Asian Mental Health, announced the group’s second National Conference in NYC October 1-2, 2004. Several AACP members are involved in the development of the conference. She invited AACP to become a co-sponsor. The Board voted that the AACP be designated as co-sponsor, and help to disseminate information about the conference.
Francis Lu, M.D., Chair of the APA Council on Minority Mental Health and Health Disparities reminded the Board of APA’s search for a new Director of Minority Affairs. He announced the availability of a video based training program, The Culture of Emotions (see AACP Summer/Fall newsletter) that introduces the DSM-IV Outline for Cultural Formulation. Dr. Lu is seeking donations to complete the project, and to honor the memory of project contributors Irma Bland and Evelyn Lee who died earlier this year.
Liaison Reports
Deerfield Behavioral Health (LOCUS) (Rick Seeger, Deerfield CEO)
Mr. Seeger reminded the Board that the primary marketing targets for LOCUS are 1) providers, 2) medium sized MCOs, and 3) state public care divisions. Recent development of an on-line demonstration tool has increased inquiries, particularly from large care systems. The District of Columbia Department of Mental Health, the Delaware system of substance abuse, South Carolina and Missouri have all purchased LOCUS and New Jersey has made a commitment. Minnesota, Louisiana, Nevada, Kentucky, New York, Iowa, Tennessee, and Massachusetts have expressed interest.
By contract, 20% of each sale goes into the LOCUS Research Reserve Fund, which ensures continued validity and reliability testing. Mr. Seeger stated that reliability and validity testing will be essential to the future of LOCUS. CALOCUS received $50,000 from CMHS for validity/reliability testing, which has already been added to the fund. Dr. Sowers commented that AACP now needs to identify individuals to conduct the research that the fund supports.
NASMHPD (Pollack)
Reporting on the most recent NASMHPD Medical Directors’ Meeting, Dr. Pollack observed a growing relationship between this organization and AACP. The MedicalDirectors meet annually before IPS. Highlights from this year’s meeting included 1) a symposium on best practices that presented data from all states, 2) a presentation by Drs. Pollock and Duckworth on premature mortality in psychiatric patients, 3) a comparison between prospective TMAP algorithm use versus retroactive review for decreasing Medicaid drug costs, 4) a report on the state of state medical directors and their task (36 states currently have a medical director.).
Demand Treatment (Sowers/Cramer)
Dr. Sowers introduced Janice Ford Griffin from the Demand Treatment/Join Together Organization. This national organization, based at Boston University, was established in 1991 by the Robert Wood Johnson Foundation to help communities develop comprehensive strategies to combat substance abuse. Demand Treatment embraces four principles. 1) Leadership needs to be established in every community to ensure that anyone who wants treatment receives it and that it is of high quality. 2) Information dissemination is essential to create savvy consumers. 3) There must be a commitment to defining quality. 4) There must be an end to discrimination against people seeking treatment. Demand Treatment provides technical assistance to 29 communities nationwide. It collaborates with SAMHSA, NIDA, and CDA. She referred the board to the resource directory on the Demand Treatment web site, and to its newsletter.
APA Council on Minority Mental Health and Health Disparities (Lim/Lu)
The Council met at the APA Fall Components Meeting, September 12-14, 2003. The Council of Minority Health and Health Disparities (CMMHHD) includes eight committees, one of which is a corresponding committee, the Committee on Religion, Spirituality and Psychiatry. The other 7 committees comprise the Minority and Under Represented Groups (MUR) of the APA, including the Committee of American Indian, Alaska Natives and Native Hawaiian Psychiatrists, the Committee of Asian American Psychiatrists, the Committee of Black Psychiatrists, the Committee of Gay, Lesbian, and Bi-sexual Psychiatrists, the Committee of Hispanic Psychiatrists, the Committee of International Medical Graduates (IMG), and the Committee of Women Psychiatrists.
The following conferences and reports were announced, including the American College of Mental Health Administration March 2003 Summit report on Reducing Mental Health Disparities, (at www.acmha.org/Summits/summit_2003.htm) the HHS Guides to Culturally Competent Health Services using the CLAS Standards. (cms.gov/healthplans/quality/project03.asp), and the June 2003 US Supreme Court ruling on Grutter vs.University of Michigan. Diversity in higher education is upheld as a compelling state interest (www.supremecourtus.gov/opinions/02pdf/02-241.pdf), and the AAMC Healthcare Professionals for Diversity coalition efforts to increase diversity in medical schools. Key issues addressed included the search for
a director of The Office of Minority and National Affairs (OMNA); Prescription
Privileges for Psychologists; the process of updating DSM-IV-TR; and access to care
issues. Since a large segment of the population in jails and prisons are ethnic minorities, each committee was asked to think about how to provide input to the Committee on Jails and Prisons, as this is one of APA President Marcia Goin’s top priorities.
SAMHSA (Everett)
Dr. Everett, recently appointed as SAMHSA Senior Medical Advisor, reviewed her job and liaison opportunities for AACP. She reported that she works in the Director’s office as a contract employee. Projects that she currently assists include 1) Disability 2) The Science to Service Project, and the 3) National Registry of Effective Programs (This will be the national reference of best practices.). The Board discussed ways that AACP might take advantage of Dr. Everett’s presence to liaison with SAMHSA. Dr. Pollack envisioned two priorities for this access: 1) establishing a dialogue between HRSA and SAMHSA regarding mental health-primary care integration, and 2) Promoting the extension of the chronic care model to treating chronically mentally ill individuals in
Community Health Centers.
APA Council on Advocacy and Public Policy (CAPP) (Pollack)
Dr. Pollack notes that he and Carl Bell are the only public psychiatrists
in CAPP. Its recent focus has been limited to privacy issues and
psychologists’ prescribing. He reports some progress directing CAPP’s
attention to the Medicaid crisis.
Old Business
Winter 2004 Meeting Update (Radke):
Dr. Radke reported on the 2004 Winter Meeting in Honolulu, cosponsored
by the State of Hawaii Adult Mental Health Division and
the Hawaii Consortium for Continuing Medical Education. The
conference theme is “Evolution of a Comprehensive Mental Health
System: From Vision to Reality”. There has been significant preregistration.
SAMHSA/HRSA Meeting (Pollack/Haas)
Dr. Pollack provided follow-up on AACP involvement in a SAMHSA/
HRSA Meeting that was discussed in a phone conference with the
National Council’s Charles Ray during the May 2003 Board meeting.
This meeting was to address mental health-primary care integration
strategies. Dr. Pollack reported that AACP was not included in the
meeting, but will continue to work with the directors of other mental
health policy agencies ( e.g. CMHS) to influence the process.
2005 AACP Winter Meeting (Ng)
Dr. Ng recommended that Washington D.C. be considered as the 20th Anniversary Meeting site. He observed that advantages of this location would include lobbying opportunities and guest speaker availability. If the meeting were scheduled for January, it would also allow linkage with the IPS program committee, which will be meeting in Arlington at that time. Several D.C. Area Board members (Ng, Osher, Everett, Majors) would be available to assist with planning. The Board approved Washington as the meeting site.
New Business
Establishing AACP Lobbyist Role (Pollack/Ng)
Dr. Pollack noted that Dr. Ng’s move to Washington DC offered AACP an opportunity to establish a Federal lobbying function there. In this role, Dr. Ng would attend Public Mental Health Coalition meetings as AACP’s Government Liaison. Dr. Ng expressed his interest in assuming this role, and added that he would need some administrative support. In its discussion the Board viewed this proposal favorably, but raised questions of whether Dr. Ng would need to be registered as a lobbyist, and whether he would retain his position as Area 2 Representative. The possibility of creating a new Board position of Government Lobbyist was also explored. Drs. Pollack and Ng will meet with Ms. Roton to discuss administrative support needs.
AACP sponsored Book on Homelessness (Gillig)
Dr. Gillig reported that APPI has expressed interest in supporting development of a guide on working with the homeless mentally ill. Dr. Gillig, who has been involved through the APA Homelessness Committee in its conceptual development, would like the book to have AACP sponsorship. Dr.s Gillig and McQuistion will serve as the editors. This project was started three years ago and a final proposal with outlines and author affiliations has been submitted. While primary authors have already been identified, Dr. Gillig invited other AACP Board members to consider becoming contributors (Paulette.Gillig@wright.edu).
Committee Reports
Disaster Committee (Ng/Thompson)
1) The Committee continues to work on the proceedings from the July 2002 CMHS sponsored meeting on Community Psychiatry disaster networks. 2) The Committee recommends support of the Congressional “Resiliency” Bill. Members can contact Drs. Thompson and Ng for further information. 3) A conference is being planned for
June 2004 in Washington D.C. on the psychosocial impact of disaster on populations. The Board voted to pursue AACP’s co-sponsoring the June 2004 disaster conference in Washington. 4) A consensus panel is being formed to address best practices for disaster response. The Committee hopes to have AACP representatives included. 5)
NASMHPD is planning five regional training sessions on disaster planning. 6) The Committee wishes to ensure that all AACP members are able to link to the APA Disaster Committee.
Diversity Committee (Lim):
1) The committee is soliciting additional nominations for free honorary AACP memberships for minority psychiatrists. 2) The Committee plans to submit a workshop proposal on Stigma and the Surgeon General’s Supplemental Report for the 2004 IPS in Atlanta. 3) In addition to seeking nominations for APA’s Director of Minority Affairs, the Committee also encourages interested members to seek positions on APA’s minority committee. 4) The Committee continues to work on contributions to the February 2005, 40th anniversary issue of Community Mental Health Journal, which will be devoted to Diversity. 5) The Committee proposes to add announcements of diversity related conferences to the AACP website. 6) The Committee plans to work with Dr. Primm to expand ‘train the trainer’ materials for “Bridging the Gap” to include Asian Americans. 7) The committee will be reviewing and revising its charter.
International Committee (Thompson)
1) The Committee will be working with APA to create an international focus at IPS. 2) The committee is looking at connecting with WHO and NIMH to create an international learning network focused on community psychiatrists. It would potentially involve student and faculty exchanges. Dr. Thompson will put together a proposal for the Winter Meeting.
LOCUS Committee (Sowers)
1) Dr. Sowers reported considerable progress with marketing LOCUS/CALOCUS to state agencies. 2) A periodic recertification process will be developed as a way to obtain formal feedback on the instrument. Deerfield will draft a survey to be used during the recertification process, and will provide survey results to the committee. 3) The Committee plans to develop a supplement that subdivides residential levels of care. This will accommodate complex residential options not addressed in the current LOCUS. The supplement will be addressed further at the next AACP meeting. 4) The LOCUS Committee will work with the Quality and Staffing Committees to modify LOCUS wording to allow greater staffing flexibility at various treatment levels. 5) The committee wishes to develop research comparing LOCUS and ASAM, as well as additional reliability testing. 6) Revisions to CALOCUS have been approved. 7) A paper on LOCUS has been rejected by Psychiatric Services, but LOCUS/CALOCUS will appear in the Best Practices column in the October 2003 issue of the same journal.
Membership Committee (Primm)
1) Dr. Primm reported that AACP’s current membership totals 648. This figure includes
526 paid members, 96 resident members (freenew category), 10 BMS fellows (free), 6 new APIRE fellows (free) and ten new diversity members (free). 2) The Committee will now begin to track the retention rate of resident members following their one-year free
membership. 3) Dr. Primm announced that in a new targeted recruitment strategy, AACP will now direct membership invitations to members of the APA State Hospital Caucus, and the NASMHPD Medical Directors’ Council. 4) Copies of the newly developed marketing packet are now ready for distribution, and will be available at the AACP booth. Other strategies to increase membership will include having Area
Representatives contact non-renewing members, developing a letter for IPS attendees
with the activist oriented theme ‘What can you do for AACP?’, and asking Board members to offer mentorship to BMS Fellows. 6) The membership committee recommends to the Finance Committee to consider increasing general membership dues to $125. In Board discussion of the Membership Committee report, Dr. Thompson suggested that consideration be given to providing time limited, free international memberships (no journal). Dr. Everett concurred, and proposed having 10 international memberships, paralleling current practice of providing 10 free diversity memberships. The proposal to provide one year free international memberships was referred to the International Committee for further development.
Nominating Committee (Huffine):
Dr. Huffine reviewed the updated election slate. (see results page 3)
Primary Care Committee (Weinberg)
Dr. Weinberg reported that the Committee has completed its most recent set of objectives, and is now at work on developing a new work plan. She noted that a likely part of the Committee’s work will involve collaboration with other organizations on dissemination of information about mental health-primary care integration. The publication by the National Council of a paper describing four operational
models for integration provides a particularly promising opportunity for collaboration. Dr. Pollack will distribute the National Council’s documents to the Board.
Program Committee (Pollack)
1) 2004 Winter Meeting plans discussed including the significant advance registration.
2) 2004 APA Meeting Presentations: The joint submissions from AACP and
NASMHPD on the impacts of budget cuts on state mental health programs, “Wither Go the States” and “Wither Go the Meds”, were both rejected by the APA Symposium Committee reportedly related to insufficient meeting space. Attempts to get this decision reconsidered and reversed have led to a potential modest compromise: one or two forums of 1.5 hours each. 3) 2004 NAMI meeting: Proposed presentations by Osher, Everett, Ng, and Primm, since they are locals. 4) Topics for the 2004 IPS: Many topics were proposed and coordinators identified.
Publications/Communications Committee
(Cutler/Faison/Oudens/Thompson)
1) Inter-organizational glitches between AACP and CMHJ’s publisher have again
delayed the placement of selected CMHJ articles on the AACP website for discussion.
Dr. Cutler will work to simplify the working arrangement with the publisher, and will soon begin to place pre-publication articles on the website. 2) Dr. Cutler announced that he will be retiring as CMHJ Editor in the near future. He will be replaced by Bentson McFarlane MD, current Associate Editor. Dr. McFarlane will become an AACP Board member. 3) Dr. Cutler announced the appearance in CMHJ of
a new feature, a section in each edition on ‘Heroes of Community Psychiatry’. 4) Dr.
Oudens reported that, as voted by the Board, publication of Community Psychiatrist
newsletter has decreased from four to three issues annually.
Quality Management Committee (Sowers)
1) Dr. Sowers reported that the AACP paper on Transition of Care Guidelines is nearly
finalized. Dr. Barbara Rohland helped him to sharpen its language, and Committee
members suggested additional changes. Dr. Sowers will electronically distribute the reedited position paper to the Board for e-mail ratification. 2) The AACP paper on Quality Guidelines for Recovery Oriented Services was approved at the May 2003 AACP meeting, and has already appeared in the AACP Newsletter. Dr. Sowers will now be working on its dissemination. Dr. Cutler will expedite publication of the Recovery
Guidelines in CMHJ. A copy of the Guidelines will be forwarded to NASMHPD
with a cover letter from Dr. Feldman. Dr. Pollack observed that the Recovery
Guidelines are already being used in State hospital program design. 3) As its next
project, the Quality Committee plans to develop Guidelines for Psychiatric Staffing
and the Role of the Psychiatrist. These guidelines would address best practices of use
of psychiatric time in public sector settings, and would develop a formula for caseloads along with other recommendations on the role of the psychiatrist.
Training Committee (Haggerty)
1) The CME subcommittee continues to refine content ideas for a ‘Medical Director Primer’ CME course to be presented at APA meetings. A launch date has not been
set. 2) As part of its Curriculum Project, the Committee has placed training curricula and training program descriptions on the ‘training resources’ section of the AACP website. Before proceeding with further development, Dr. Haggerty will assess the hit count for
this page to determine if this information is currently being used. 3) Dr. Gillig reports progress on development of training tools for MR/MI treatment. She has constructed a list of 12 MR/MI competencies and plans to examine strategies for achieving them. She
would like to develop an AACP- sponsored Guide to Treatment of Individuals with Mental Retardation and Mental Illness. 4) The Training Network Meeting is currently ‘on vacation’ while it seeks a new focus. One possibility could be an examination of how to achieve RRC core competencies in Community Psychiatry. Another issue proposed by Dr. Thompson is a conversation on academic promotion for community
psychiatry educators. 5) The Community Psychiatry Program Directors list needs updating.
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