How could you, as APA president, address the issue of including disability in the definition of diversity in the applied sense (e.g.; development of cultural competency in disability among psychologists)?
APA has included disability in its definition of diversity. It is known that individuals with disabilities are among the most marginalized groups, and as such they are at a higher risk for stigmatization and subsequent health disparities. I am well aware of this in my practice. As stated previously, I am Board Certified in Clinical Health Psychology, working primarily with patients with chronic medical conditions, with an emphasis in working with patients with chronic pain. A large number of my patients have disabilities, and I have seen firsthand the difficulties they have encountered in attempting to obtain access to adequate health care. I intentionally chose to practice in an ADA-accessible location and space to ensure that I could evaluate and treat patients with cognitive and physical disabilities. My clinic is easy to find geographically, located close to main areas of traffic and public transit, has a wheelchair ramp, there are no steps, has accessible restrooms, and is a large, well-lit office space. My candidate website for APA President-Elect (www.jfkforapa.com) is also accessible for people with vision impairment.
One of the ways to combat stigmatization and lack of knowledge about working with people with disabilities is for psychologists and others in the health care field to become culturally competent in working with patients with disabilities. As you know, the number of psychologists who are culturally competent in working with people with disabilities is limited but increasing. Many of my colleagues do not treat people with disabilities or ensure that their clinic is accessible. I want to help increase the cultural competency of psychologists to work effectively with people with disabilities, particularly given that the demographics of the country are constantly changing, and they will be increasingly more likely to see more patients with disabilities in their practice.
It elected president, I plan to draw attention to health disparities with my presidential initiatives and I plan for my colleagues in Division 22 to help me in these efforts. The initiatives provide opportunities to improve this challenging situation in several ways:
- Enhancing and ensuring services, education/training and researching best practices for the Seriously Mentally Ill/Severely Emotionally Disturbed (SMI/SED). This initiative provides an excellent opportunity to highlight the need for psychologists to focus on best practices in the evaluation and treatment of individuals with physical, sensory, intellectual, and motor disabilities as well as disability related to severe mental illness. This would be a large step forward in assisting psychologists to become culturally competent in this area.
- Focus on research, education/training and service expansion and inclusion in Integrated Care. This focus provides a unique opportunity to highlight disability issues. My integrated care initiative should draw attention to the need for competence to treat a wider range of patients including those with chronic physical and mental health disorders, and appropriate reimbursement for services offered, such as through Medicare.
What do you see as health service psychology’s role in health care reform efforts and legislative advances, particularly as they affect those with disabilities and chronic health conditions?
Psychology has been and continues to be very involved in health care reform efforts and legislative advances. We have fought to include mental health and substance use disorders services at parity with physical health services and to integrate mental and behavioral health services into primary care and other health care services. As one of the co-chairs of the newly formed APA Advocacy Coordinating Committee, I am committed to making sure that individuals, especially those with disabilities have access to adequate mental health care. For example, one of the legislative priorities is to have passage of the Medicare Mental Health Access Act/Physician Definition bill, allowing psychologists to practice to the fullest extent of their training and licensure. At this time, Medicare is the only health care payer that continues to require physician oversight, supervision or prior authorization of psychological services in outpatient rehabilitation facilities, partial hospitalization programs and other treatment settings outside of a psychologist’s office. This change would allow psychologists to see Medicare beneficiaries independently in all covered treatment settings, including nursing homes, rehabilitation facilities, and rural health shortage areas. We need to advocate for psychologists at academic health facilities to be consistently treated as equivalent to physicians for admitting and voting privileges and access to Medical staff resources. It is also vital that APA continue to support efforts to educate our legislators about disabilities, working with and evaluating/treating people with disabilities, parenting with disabilities (Dr. Erin Andrews’ testimony regarding parenting with disabilities was pivotal in this effort), and the importance of funding for research and education/training in this area. If elected president, I plan to continue these efforts and use my presidential platform to draw widespread attention to them.
How can psychology meet the needs of our largest minority consumer, the nearly 1 in 5 individuals in the U.S. who have a disability?
Division 22 and the Committee on Disability Issues (CDIP) have played a vital role in forwarding initiatives within and outside APA including resolutions and policy regarding testing and treatment of people with disabilities. APA, through its’ active Office on Disability Issues and government relations (GR) staff, have assisted psychologists in CDIP and Division 22 to address disability issues at the policy level through grassroots efforts, APA GR staff visiting with legislators, and testimony such as Dr. Andrews’ noted above. These groups and the coalitions they participate in have been relatively effective in ensuring psychology meets the needs of individuals with disabilities. There is much more to be done, including increasing a focus on disability issues and cultural competence in our training programs. The training programs need to reflect the fact that the demographics of the country are changing, and that approximately 20 percent of the population have some form of a disability. Finally, we need to increase the funding for research and increase the number of research psychologists focusing on disability issues and improving lives for individuals with disabilities.