Resilience is the human ability to adapt in the face of tragedy, trauma, adversity, hardship, and ongoing significant life stressors. Focus groups conducted by the APA Practice Directorate after the terrorist attacks of September 11, 2001, found people to be experiencing a chronic sense of stress and uncertainty for which they wanted to be more resilient. In response, APA launched its public education campaign, "The Road to Resilience," in August 2002. A key component of the campaign is community outreach by psychologists, in which psychologists around the country bring information about resilience directly into their communities. This has allowed psychologists to help their communities and to help communities better understand the value of psychology.
The authors conclude that the PDP successfully achieved a primary objective for which it was established by demonstrating that licensed psychologists can be trained to provide safe, high-quality pharmacological care. As such, the project serves as a foundation for efforts to include prescription authority in state licensing laws and for the further development of a psychological model for prescribing. The Department of Defense (DoD) Psychopharmacology Demonstration Project (PDP) has been one of the most intensively studied and widely scrutinized experiments in the training of non-physicians for prescriptive authority. The result of Congressional action in 1988, the PDP training program was initiated in 1991 by the DoD as a demonstration project to train already
The progress of psychology toward the acquisition of prescriptive authority is critically reviewed. Advances made by other nonphysician health care professions toward expanding their scopes of practice to include prescriptive authority are compared with gains made by professional psychology. Societal trends affecting attitudes toward the use of psychotropic medications are reviewed, and the potential influence of such trends on the prescriptive authority movement is examined. A history of the prescriptive authority movement is documented, and recent legislative and policy initiatives are discussed.
A national survey of the states and territories revealed that the vast majority of state courts allow psychologists (and other nonphysician health care providers) to serve as forensic experts. Over the past decade organized psychology has been similarly successful in removing all known legislative and administrative barriers to its participation in the federal judicial system. The American Bar Association's criminal justice mental health standards provide for parity with medicine.
Although some form of capitated health care has been in existence for many years, such as that sponsored by Kaiser Permanente, recently there has been a virtual explosion in alternatives to the traditional fee-for-service model of health care. Managed care, as it has become known, grew out of substantial changes in the economic realities of the health care marketplace in a n attempt to contain the rising costs of health services.Some people have argued that within the fee-for-service delivery system, health care was provided without regard to cost, and often without regard to necessity. This resulted in continued high costs of care during a period when the general economy was experiencing deflation. New cost-control and costreduction methods integrated into the service delivery system to prevent continued health care inflation have ultimately shaped the direction and spurred the growth of managed care. Enrollment in health maintenance organizations (HMOs), for example, grew 11.9% from December 1986 to September 1987, and included 28.8 million members. It is estimated that by 1993, 50 million people will be enrolled in HMOs nationwide (Martinson, 1988). This dramatic growth has been stimulated, in part, by legislation that removed some legal and financial obstacles to the creation of new managed-care entities.Reaction to this change in the health care industry, particularly in the mental health care arena, has been mixed. A survey of psychologists and other mental health care professionals who subscribed to Behavior Today revealed that 86% of respondents believed that the quality of mental health care suffers when provided through managed-care structures ("BT Survey Results," July 20, 1987). The most frequent reason cited for the concern about quality in managed care was the limits or caps placed on the number of sessions a patient could receive-a complaint expressed by 79% of those surveyed. Other major complaints expressed included increased paperwork (67% of the respondents), the gatekeeping system (55%), decreased flexibility in the treatment ap-
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