2015 APA President-elect Candidate Statement
PSYCHOLOGY IS MY PASSION AND CALLING. THAT IS WHY I HAVE SPENT 35 YEARS HELPING PSYCHOLOGY HAVE A SEAT AT THE TABLE.
APA HAS STOOD FOR THE INTERFACE OF SCIENCE, PEDAGOGY, PRACTICE AND PUBLIC SERVICE. THE FOUR SERVE AS FOUNDATION FOR MODERN PSYCHOLOGY. BUT FOR FAR TOO LONG EACH LEG HAS STOOD IN ISOLATION FROM THE OTHERS.
PSYCHOLOGY IS FACING WINDS OF CHANGE AND UNCERTAINTY. WE ARE BEING CHALLENGED BY CONGRESS, LEGISLATURES AND THE PUBLIC TO PROVE OUR WORTH. SOME HAVE GIVEN UP, ACCEPTING THE STATUS QUO, NOT JOINING OR LEAVING APA BELIEVING THAT THE DREAMS THAT BROUGHT THEM TO PSYCHOLOGY ARE NO LONGER ACHIEVABLE.
I AM NOT WILLING TO ALLOW OUR PROFESSION, WHOSE FOUNDATION IS BASED ON SCIENCE, TO BE BEATEN DOWN. NOR AM I WILLING TO ALLOW PSYCHOLOGISTS TO BE LEFT BEHIND.
THIS UNCERTAINTY IS AN OPPORTUNITY TO DEVELOP A NEW COMMON VISION FOR PSYCHOLOGY- AN APA FOR ALL MEMBERS.
GEORGE MILLER SAID HALF A CENTURY AGO “GIVE PSYCHOLOGY AWAY”. I SAY, “BRING PSYCHOLOGY BACK”. AS A TEACHER, SCIENTIST, CLINICIAN AND POLICY MAKER NOT ONLY DO I BELIEVE THIS VISION, BUT I LIVE IT NOW MORE THAN EVER AS A FATHER OF TWO APA MEMBERS.
THE FOLLOWING WILL BE ACCOMPLISHED:
THIS IS WHAT I WANT FOR MY CHILDREN, STUDENTS, CLIENTS, AND YOU BUT MOST OF ALL FOR SOCIETY. LET US DREAM AND WORK TOGETHER TO PLACE APA WHERE IT SHOULD BE-
A LEADER IN TODAY’S WORLD.
I AM TONY PUENTE AND PROUD TO BE A PSYCHOLOGIST. I WOULD BE HONORED AND PRIVILEGED TO SERVE YOU AS PRESIDENT OF APA.
- DEVELOP A TASK FORCE TO INVIGORATE INTEGRATION WITHIN & OUTSIDE OF APA.
- ADDRESS DECREASING APA MEMBERSHIP.
- THE INTERSHIP CRISIS WILL END.
- OUR ADVOCACY MESSAGE WILL BE COHESIVE AND INTEGRATED ESPECIALLY FOR THE PRACTICE OF PSYCHOLOGY.
1. How will you integrate/reflect APA’s commitment to diversity in all of your presidential endeavors?
In 1892, 31 diverse individuals met at Clark University to form the American Psychological Association with a vision for “a new psychology”. Diversity included different training, geography, and intellectual interests. Our history should be extended.
Almost 125 years later, diversity within APA has expanded to include social justice, equitable representation and treatment for all. APA membership should match society’s demographics by engaging targeted recruitment. Among diversity, greater attention within APA should go towards ethnic-minority, disability, SES and LGBT concerns. Finally, APA should look beyond our borders to make psychology truly generalizable to the world.
An APA for all members.
2. There are multiple changes to APA’s governance structure underway. What is one major opportunity this change offers the association.
The existing governance of APA was created half a century ago. The Good Governance Project (GGP) presents a unique opportunity to engage the membership, democratize governance, increase organizational efficiency as well as develop and apply targeted strategy.
The details to be worked out pose the greatest challenges for the GGP. Membership engagement must be increased and member concerns should be continuously monitored and serve as the foundation for strategic impact. This broad base approach should be supplemented by council and presidential leadership as well as expert panels. The future of APA depends on governance that is simple, flexible and visionary.
3. How do you envision increasing and enhancing the vitality of the association’s membership?
Our organization, like other professional associations, has been steadily losing membership over the last few years. I consider this a major issue for APA and my/our campaign. APA will establish a more personal relationship with our members and the value of the organization will be made clearer. In a recent survey study we completed, the following suggestions were made to resolve this issue: 1) Regular surveying of members to determine their needs. 2) Expansion of APA’s recruitment campaign. 3) Engagement efforts focused on new members of APA. 4) Targeting specific groups for membership (e.g., ECPs, ethnic-minorities, scientists, and prior members).
4. What role should APA undertake in the public discourse of political, legal, and social issues?
APA has a long and rich history of engagement with society. In a recent survey study we completed, the respondents indicated on a 5 point Likert scale that APA should be involved with political, legal and social issues “quite a bit” (4 out of 5). Further, numerous and complex issues are presently facing us, ranging from social unrest to terrorism. The Board of
Directors and Council of Representatives should vet issues, plans, engagement and outcomes
with regular membership input. However, discourse among colleagues must be transparent
and professional. An APA for all members!
5. What actions would you take to enhance the future of psychology in an era of increasing
interdisciplinary education, research, and practice?
APA and psychology cannot stand-alone in the increasingly globalized and interfaced world.
The most obvious and critical need is in practice and specifically is the inclusion of
psychologists in Medicare’s definition of physician as well as to and obtaining a CPT code for
reimbursement of integrative healthcare. These ideas are illustrated in National Academies of
Practice’s (honorary multidisciplinary healthcare organization) Journal of Interprofessional
Education & Practice of which I am founding co-editor. Further, we must encourage our training
programs to teach interdisciplinary competencies. Examples include focus on interdisciplinary
competencies (neuroscience) and research (cognitive science). An APA for all members!
6. How would your presidency work to expand international perspectives within APA and
facilitate the internationalization of psychology in education, research, practice, and
In a recent survey we completed, the following initiatives were considered important (in order):
promoting an international perspective within APA, increasing contact and conversations across
borders, bridging diversity around the world, and promoting an international perspective in
graduate training. As a Fulbright scholar and life member, I believe that education across borders
increases both global understanding and a more generalizable psychology. I am Visiting
Professor at the Universidad de Granada and most of my post-docs have been from foreign
countries. Finally, I will visit Cuba in December to solidify APA’s prior efforts to establish
formal relations with my native country.
Recent Healthcare Changes Affecting the Future of the Independent Practice of Psychology
Recent Healthcare Changes Affecting the Future of the Independent Practice of Psychology
Antonio E. Puente, Ph.D.
Data from CMS provide a glimpse of the healthcare
tsunami that we are in the midst of. From 1960 to 2015,
healthcare spending increased from 5% of the gross domestic
product to over 20%, totaling approximately $4 trillion
dollars. In comparison, the US spends two times as much as
the United Kingdom and four times as much as China.
Realizing the complications associated with such expenditures,
US Presidents since 1912 and continuing to the present with
Barack Obama have attempted to address this complication.
To address this situation, the Affordable Care Act
(ACA; HR 3962) was passed. In doing so, 34 million
individuals were expected to be enrolled, although as of
September 2015 only 9.6 million (higher than expected
actually) have enrolled. The ACA has introduced novel
concepts in healthcare including:
1. Health care homes
2. Focus on primary and preventative care
3. Electronic health records
4. Banning of limiting individuals with pre-existing conditions as well as lifetime caps
5. Increased focus on integrative care
The question is raised for this article is as follows: How will
the introduction of the ACA affect the independent practice of
The following are some likely effects, which are based
on my understanding of the ACA and my work on the American
Medical Association’s Current Procedural Terminology (CPT)
since APA was given an opportunity in 1992 (first as APA’s
advisor to CPT and for the last six years as one of 17 voting
1. The action will shift from Washington, DC to state
capitols. Further, the lowest common denominator in terms
of state interpretation of the federal ACA will determine the
legally binding denominator from which all other states will
be judged. This will replace Medicare as the new benchmark.
2. An increase in fraud and abuse focus will occur first
with Medicare, then Medicaid, then private payors. The shift
to private payors is presently occurring.
3. There is a paradigm shift presently occurring that
will change reimbursement from fee for service to fee for
outcome. The first step in that shift is occurring and will
probably continue through 2018. The focus will be exclusively
on documentation. Starting with 2018 and the new MACRA
program, the focus will shift from documentation to outcome.
How outcomes will be measured in behavioral health is yet
to be determined.
4. Patients/clients will be part of a medical or healthcare
home in which a physician or probably an independently
licensed Qualified Health Provider (QHP) would be primarily
responsible for handling the care (and economics) of that
patient. These “homes” may be geographically (e.g.,
building) or electronically defined (e.g., sharing the same
5. The focus will be on chronic illnesses and their
prevention. Critical illnesses, such as diabetes and chronic
depression, will be targeted and incentives to change
outcomes (e.g., hospitalizations) will be provided. In addition,
greater emphasis will be placed on preventing the
development of these diseases with annual check-ups,
well visits and education.
6. The difference between physical and mental health
will slowly disappear. Carve-outs, differential physical and
mental health limitations and caps will disappear. Along with
that will be increasing acceptance of mental disorders and
the integration of behavioral health assessments and
interventions with traditional medical problems and
7. Two types of professional psychology will slowly
emerge over the next five years. One is a volume type
practice that will generate relatively little profit per patient
but will have significant profit across a wide spectrum of
services and clients as well as geographic boundaries. In
addition, reimbursement will be insurance based and
salaries will be Relative Value Unit based. In
contrast, there will be niche or boutique practices that will
focus on personalized care (e.g., 24 hour on call), unusual skills
sets (e.g., bilingual), accessibility (e.g., quick appointments),
and cash (i.e., no insurance). Whereas the profit per patient
will be significant, the total profit may not be that different
than the volume practice.
In summary, the practice of today will change over the
next 5 years at the most dramatic rate in our lifetime.
Understanding and anticipating these changes will allow one’s
independent practice to evolve and prosper. Though bundling
of services and group/multidisciplinary practices will begin to
increase over time, the independent practitioner model will
persevere and, possibly, even prosper as clients seek more
customized and personal service(s).
Division 20: Adult Development & Aging
Division 20: Adult Development & Aging
Antonio E. Puente
1. Do you have any your interests and/or any previous involvement in Division 20? Our members would be interested in knowing if you are a member or fellow of the division and if you have been active in any way in Division 20.
While not a member Division 20, many of the issues addressed by Division 20 have also been issues inherent in my work over the last 35 years. Primarily my clinical focus has been in the clinical neuropsychological assessment of adults and the aged.
2. Do you have any professional or scholarly interests in issues related to the psychology of adult development & aging? Naturally, we are interested in a wide range of professional activities, including practice, consulting, supervising, research, teaching, and involvement with any other organizations devoted to adult development & aging and/or the psychology of aging.
Clinical- My most typical client at private and institutional practice (1982-present) is a dementia patient and the most typical activity is a neuropsychological evaluation for treatment purposes. One of the unique aspects of my practice is that a significant percentage involves the assessment of Spanish-speakers (my native language) and often in forensic situations (e.g., competency). A fair amount of this service is done along with my bilingual students and post-docs (most are Spanish speaking) at a free clinic (Cape Fear Clinic) I founded 15 years ago. Finally, I am a regular speaker at the local chapter of the Alzheimer’s Association focusing on caregiver issues (as I happen to be one).
Scholarly- From a scholarly perspective, I am a reviewer for several aging/adult development journals such as the Journal of Gerontology. I have been a reviewing consultant for Alzheimer’s Association- Awards & Grants Office for several years (2009 – Present). Here are some examples of publications related to adult development and aging.
• Horton, A.M., & Puente, A. E. (1990). Life-span neuropsychology: An overview. In A. M. Horton (Ed.), Life-span neuropsychology (pp. 1–15). New York, NY: Springer.
• Puente, A. E. (2002). Neuropsychology: Introducing aging into the study of brain and behavior. In J. C. Cavanaugh & S. K. Whitbourne (Eds.), Integrating aging topics into psychology: A practical guide for teaching undergraduates (pp. 29–42). Washington, DC: American Psychological Association.
Academic- In teaching Brain and Behavior as well as Clinical Neuropsychology, adult development and aging is the central core of what is presented in both standard lecture and practice settings. My primary training focus at the graduate and post-doctoral levels are Spanish-speaking and international students. Currently, I am training three graduate students (from Canada, Honduras, and Japan) and post-doctoral fellows (Spain and Russia).
3: Could you briefly explain any way in which adult development & aging is part of your platform or agenda for your presidential year?
Originally, my primary platform was to expand the role of psychology into all of healthcare (see Puente, 2011, Psychology as a health profession in American Psychologist). For far too long, professional psychology has focused on mental health. My goal is to expand the horizons of professional psychology to ALL of healthcare.
•Of interest is that I serve on the AMA CPT Panel, which determines what health care can be done in the US and how much it is reimbursed (only psychologist in its history and third non-physician). I served as APA’s advisor for 15 years and have served as a voting member of the panel. We are revamping all the psychological assessment codes now and addressing the problem of “screening” for dementia by non-trained individuals.
Many issues are facing an aging population and for that matter APA. Having a neuropsychologist (who has worked with these kinds of patients for years) for APA president will only help bring these kinds of issues to the forefront of concerns to be addressed by APA & psychology.
Having summarized my “original” platform, I have to be honest. This is seriously aspirational. We have to place our personal agendas to the side right now. A much more critical, timely and challenging concern is the rebuilding of APA. For example, with a significant percentage of the Board of Directors and APA’s Executive Management fired, resigned, or recused, our organization appears to be a boat without a rudder. As much I want to infuse psychology into all of healthcare, we need to infuse integrity, transparency, efficiency and no drama into APA. It is time for a rebirth of APA and to reestablish as a preeminent pedagogic, professional, and scientific society.
Thank you for the opportunity to provide responses to Division 20. Tony Puente
- Antonio E. Puente
1.Your views about board certification in psychology?
Unlike physicians, many psychologists have not considered board certification important. In the past, when clinical positions were plentiful, psychologists could practice without submitting to peer-review. Health care reform will result in a greater need for psychologists to consider board certification. As psychologists become part of an integrated health care team, they are increasingly being required to have credentials similar to those of physicians, with board certification specified in the health system or care entity by-laws. If we wish to be equal partners in the next generation of qualified health care providers, psychologists will have to adopt similar standards. ABPP is poised as the single most comprehensive and accepted board certification process.
2.Views concerning specialization within psychology?
The future of professional psychology will require that all clinicians to specialize including those that provide general clinical services (similar to family physicians). This vision would have all individuals practicing to be specialized, whether they are involved with existing specialties (e.g., clinical neuropsychology) or in traditional clinical psychology (e.g., clinical psychology providing psychotherapy for mental health disorders). What is missing at this point is 1) increasing the percentage of ABBP psychologists to more than 50% of licensed psychologists and 2) the credentialing of individuals that are engaged in integrative care. The focus would be to embed board certified psychologists in all of health care, both behavioral and physical, as a means to increase health care efficiency and decrease health care expenditures.
3.How can APA & ABPP work together to improve our field?
Both groups should work together to ensure that there are a significantly larger percentage of ABPP psychologists in all healthcare settings. Encouraging students to engage in the ABPP process while in training programs could start with integration of the concept of board certification in courses. Student involvement in all ABPP conferences and activities (e.g., scholarships to attend meetings) should be considered. Training accreditation, from internship to post-doctoral should assess whether programs that have enough staff who are board certified. Greater employment opportunities, employer support for board certification, and salary bonuses should also become standard for clinical employment.
4. If elected, how can ABPP help with your presidential agenda?
I would like to establish a task force including representatives from ABBP, other peer review groups and state licensing boards to study how to make the board certification process the standard rather than the exception for professional psychology. In addition, this task force should consider addressing bringing in both our younger and more seasoned colleagues that have chosen either other paths of peer review or not chosen to pursue this process. Working together with all our colleagues to pursue the goal of board certification for the majority of professional psychologists will be critical for the future of professional psychology.
Society for the Science of Clinical Psychology
- Antonio E. Puente
Questions for APA Presidential Candidates
Society for the Science of Clinical Psychology (Division 12, Section 3)
1. How will you support clinical science in guiding practice (e.g., promoting use of evidence-based, empirically supported assessments & interventions)?
Since 1978 my career has involved the practice, pedagogy and science of psychology. I have practiced psychology- in a teaching psychiatric hospital, an academic medical center, group psychology practice, a multidisciplinary medical group and in solo practice (in that order). I have continuously been teaching undergraduate (7,500), graduate (thesis = 35) and postdoctoral fellows (13) here and abroad (mostly Spain). Finally, as www.antonioepuente.com indicates, I have published 8 books, 76 chapters and 110 articles in English, Spanish and Russian. In other words, my professional life has been nothing more than being part of and promoting the scientist-practitioner model.
Of special interest and focus for the last 25 years has been advocating for empirically based practice as the foundation for the profession of psychology. This has been done as a representative of APA for 15 years to the American Medical Association’s (AMA) Current Procedural Terminology CPT) panel (see www.psychologycoding.com). For the last six years I have served as one of 17 individuals on the voting panel of CPT along with CMS/Medicare, Blue Cross/Blue Shield and representatives of AMA. Only scientifically vetted practice gets on the agenda and even then diplomacy, networking, and resiliency is what eventually becomes accepted practice.
In other words, for 25 years I have helped shape the practice of psychology that is empirically based. This history will serve as the catalyst to emphasize, support and expand clinical science foundation of APA activities. Of special interest would be to encourage empirically supported position papers and policies of/for APA.
2. How will you support clinical science research, particularly in light of reductions in research funding for psychosocial and intervention research?
The most significant challenge facing the clinical science of psychology is the lack of funding. As a personal example, I submitted over $2 million in grant funding requests to NIH, NSF and private organizations in the last two years. I have a 25% funding success rate. This is a start-up grant with an angel-fund and the assumption is that the investors expect a return on their investment while I expect answers to questions. This is one way we have to conceptualize the future of funding.
However, I am also of the opinion that we have to have a stronger lobby and presence with funding agencies and Congress. Specific activities include: educational sessions sponsored by the Science and Practice Directorates for congressional staffers on the hill, Congressional hearings on the role of scientific behavioral health in increasing effectiveness in Affordable Care Organizations and free subscriptions of our publications to Congressional leaders are specific activities, which APA could easily achieve.
3. How will you support clinical science in education across the life-long training pipeline?
As mentioned previously, I have been involved in education and training of psychologists since 1978. For example, I have run a bilingual multidisciplinary and mental health free clinic for 15 years where we train students, from undergraduates to post-doctorate fellows (presently from Spain and Russia).
Organizationally, I have chaired several APA committees and boards including the Committee for Undergraduate Education, Continuing Education and the Board of Convention Affairs as well as conventions of the North Carolina Psychological Association, the National Hispanic Society and the National Neuropsychology Academy (including being president of the last three). Of more recent interest is my goal of promoting a national conference on teaching psychology in high school. This would help address my personal commitment to consider the science of psychology as starting in high school and continuing throughout the life of an individual’s academic and/or professional career.
4. How will you promote psychology as a STEM discipline? How do you see clinical psychological science – and health service psychology - as fitting the definition of a STEM discipline?
Without being a STEM discipline there is no link to our long and rich past nor there be a future for our discipline. For me the similarities between medicine and psychology are that we hold true to a focus on health care and to science. The differences are in that one focuses more on physiology and the other on behavior. One without the other is incomplete and ineffective.
However, the only way to get a seat at the health services table is to do so through science. My work with CPT is reflective of such. Science gets you to the table; other variables allow you to walk away successfully. In my professional life my practice is informed by my research. Specifically when I became involved in neuropsychology there were no instruments in Spanish in our field. Today there are several and we are continuing especially with our collaborations with colleagues in Central America, Mexico and Spain. A recent example is that this week we launched our work on the translation and adaption of the Wechsler Intelligence Scale – V in Spanish.
In summary, my plan is to promote psychology as a STEM discipline both personally and organizationally. As with medicine and psychology, one effort without the other makes for an incomplete paradigm.
Division 42: Psychologists in Independent Practice
Division 42: Psychologists in Independent Practice
Questions for President-elect Candidates
Antonio E. Puente
06.15.151. Please describe your contributions to the independent practice of psychology.Policy: – Shaped healthcare in America by participating in the AMA CPT process for 25 years (on the voting panel for the last 6 years). Expanded reimbursable activities through the AMA CPT system from 5 to over 50 codes, including expanding psychotherapy and testing opportunities. In addition, I worked towards parity within the Medicare system – Medicare Coverage Advisory Committee for 5 years Practice: – Started private practice services 33 years ago (neuropsychological, rehabilitation& forensic services) at a private group practice (Carolina Counseling Center-1982) multidisciplinary health clinic (Wilmington Health Associates-1994) and solo practice (University Neuropsychology-1999). See clinicalneuropsychology.us Training: – Has provided clinical training and supervision to over 34 graduate students and 9 post-doctoral fellows as well as 5 interns from the US and 6 foreign countries. Service: – Numerous committees and positions at APA (e.g., Ethics and, most recently Testing Standards) STPA (e.g., NCPA and NCPF President). Together with one of my children, I established and now co-direct the mental health service Cape Fear Clinic for indigents (16 years).
2. What do you see as the most important issue(s) facing the independent practice of psychology? How do you intend to address these issues during your presidency?
According to three surveys last year and one more this year thus far, (www.puenteforpresident.com/survey-results), by far the most critical aspect is reimbursement for psychological services together with inclusion of the psychologist in the Medicare’s definition of physician. The role and reimbursement of integrated care is also important. As I have for over 25 years, I would continue to expand the range of services that psychologists provide into the entire health care arena while building out historical mental health focus. I would personally attend all CPT meetings, even if required to resign, and place greater emphasis on the Office of Health Care Economics as well s increase the transparency of the critical work of APAPO.
3. Explain how your initiatives will incorporate or make contributions to issues important to those in practice?
A) Foremost will be to place whatever resources are necessary to include psychologists in the Medicare’s definition of physician.
B) Having been in practice since 1982, being elected as President of the APA as well as on sitting on the AMA CPT panel (while President-elect) would have significant public relations impact and emphasize the central role of professional psychology within APA and AMA.
C) Make practice the central focus of the Presidential Initiative by having a Task Force appointed to review all activities done by APA that affect the practice of psychology.
D) Use the results of the recent and continuing surveys found at www.puenteforpresident.com to inform primary issues of concern to the practice membership E) Increase understanding of what APAPO does and match as closely as possible what the practice community needs to what APA does.
4. Please list and describe any positions held/committee work you have been involved with in Division 42.
Positions and committee work can be those held in the past and/or currently. I have focused my efforts on my state association (e.g., President, North Carolina Psychological Association and the North Carolina Psychological Foundation) and APA as a whole (e.g., Chair of 6 APA Boards and Committees and member of another 10). However, my focus has been on the independent practice of psychology across all these activities, just not within 42. I have done a town hall meeting for 42 members and am unveiling a series of 5 complimentary monthly webinars on using the CPT system for the practice of psychology starting
5. Please describe any contributions you have made to Division 42.
I have not made direct contributions to Division 42 but have made numerous contributions to the independent practice of psychology as evidenced by APA’s Lifetime Achievement Award to Independent Practice. Relative to the mission of 42 is that I have two children in psychology, daughter with PsyD (FIT) in hospital practice in Florida and a son with a clinical PhD completing post-doctoral fellowship in clinical neuropsychology at Johns Hopkins. A third child just completed his PhD in political economics at Stanford and worked the Obama team that drafted early versions of the Affordable Care Act. Whereas I have not been active in 42, my career is a mirror to the mission and scope of the Division. Over the last 2 years, I have becoming increasingly involved in Division activities and the trajectory is to continue this path.
6. Current antitrust laws have significant negative impact on reimbursements for psychological services. What concrete measure(s) would you take to address this issue on behalf of psychologists in independent practice?
A legal and potentially antagonist approach to issues such, as parity was historically useful but currently ineffective. The time has come for a new strategy that resolves the core of the problem rather than its potential result. I propose a two-step strategy: 1) Work on protecting and expanding the scope of practice at the national level through policy development (AMA CPT, CMS). The best example is the 10-year history to develop more appropriate codes and reimbursement for psychotherapy services through the CPT process. In this case I used parliamentary procedures at CPT to block psychiatry from placing psychology in a permanent second level of practice (Which has caused significant problems with my engagement with the CPT panel- something that I am working hard to resolve. 2) Specific legislative issues should be addressed at the state levels (e.g., NCPA’s opening and fixing the psychology practice act; use of the IOPC 360 Model to change reimbursement rates in several states and within several carriers (and plans). I am not opposed and have been involved in litigation but APA has made significantly strides in building professional collaborations and relationships with other health care organizations.
7. How do you propose to improve upon the funding and viability of the APA Practice Organization?
A) Education of all APA members who are in practice of what APAPO does and campaign for 100% support of the dues assessment. B) Support the returning of APAPO settlement to APAPO. C) Develop other revenue producing opportunities (e.g., consultation, publishing). D) Study the relationship of existing budgetary lines and APA membership needs, especially for those practicing psychology independently (as I do).
8. What do you see as APA's responsibility in the areas of integrated care, licensure mobility and telehealth?
I personally am supportive of each of theses three areas. In terms of integrated care, I have started a journal called Journal of Integrative Education & Practice (Elsevier) and have led the charge within AMA and within APA to establish a CPT code for integrative care. I am keenly interested and provided feedback regarding the work being doing by my State Licensing colleagues. Finally, I have worked on developing CPT code compatibility with every psychological service typically done by psychologist except testing (and that is coming). The immediate future for the practice of psychology hinges on successful implementation of all of these three areas.
Division 38: Health Psychology
Division 38: Health Psychology
Antonio E. Puente
What do you see as the biggest challenge facing health psychology in the changing healthcare environment?There are numerous challenges facing psychology, in general, and health psychology, in particular, during the tsunami of healthcare changes. In a recent survey we recently completed of approximately 10% of the APA voting membership, without a doubt the biggest challenge the survey respondents indicated was the inclusion of psychology in the Medicare definition of psychology. Right behind that challenge is how a health psychologist is to become integrated with the entire healthcare system as an equal partner. This is about parity by access, by impact and by income.I have worked to ameliorate this situation for the last 25 years at the national by my participation in the Current Procedural Terminology panel, first as the American Psychological Association’s advisor to the panel and now as one of 17 members on the voting panel (and only the 4th non-physician in the history of the panel). I believe in the idea that change is occurs from the ground up, in this case at the state level. I have worked through my state association (e.g., President), North Carolina Psychological Association, to realize the dream of true parity at the state level. Now I realize that working in silos, organizationally, is like working in silos, clinically. Its time has come and gone. Organizationally federal mandates must match state realities just as health psychology can no longer have the impact necessary without being considered a physician and cohesively integrated into the entire healthcare system.
Given the current emphasis on specialization and certification, how do you express the value of psychology as a unified professional identity?
We are first psychologists and we are second specialists. The value of a unified professional identity, Psychology First, must start at the pedagogical level. Psychology training at the doctorate level must be generally uniform, at least through the masters’ degree, and then minimally specialized. Clinicians should receive their training in cohesive programs that make them first and foremost clinical psychologists. Specialty training in health psychology, much like medicine, should occur after the doctorate degree. If a health psychologist has more of an academic focus, then it would be crucial to have exposure and engagement of clinical training activities much like the clinically focused health psychologist should similarly be trained in either the scientist-practitioner or clinician-scholar models. This unified principle should continue as specialization of research and certification of competency drives an imaginary wedge into health psychology. There is no reason why the integration of science and practice should become a sign of separatism. Instead science without practice and vice versa leaves a future and legacy for health psychology that will undermine its potential impact for understanding and treating disease and wellness.
Division 17: Society of Counseling Psychology Endorsement
Antonio E. Puente
Division 17: Society of Counseling Psychology Endorsement
1. Briefly state your current or past involvement with the Society of Counseling Psychology (SCP) and how your involvement has served to further the mission, activities, and values of Counseling Psychology and of the Society.Though not a division member or fellow, my personal academic, professional and scientific career and perspectives mirror the mission of Society for Counseling Psychology.
First and foremost, I am Hispanic, my native language is Spanish, and I have lived a multicultural life and developed a career than mimics that life. In addition, I have two children that have pursued psychology, a PsyD and a PhD. Both are bicultural and bilingual and serve ethnic-minority clinical populations as psychologists.
As illustration, let me begin by sharing my involvement with a free clinic for the poor and uninsured in our community. Approximately 15 years ago my daughter volunteered at a local free clinic translating for medical patients. After she encouraged me to join her, we realized the unusually high need for mental health services. Since starting a bilingual mental health service then (mostly psychotherapy), we have grown the clinic to over 500 clients and have a volunteer staff of undergraduates (administrative) and graduate students as well as post-docs and former students. We provide diagnostic and therapeutic services in English (60%) and Spanish (40%).
I am similar committed ethnic-minority issues with the largest percentage of my research being devoted to the interface between cultural and neuropsychological variables. My next formal talk will be in June at Palo Alto University on that interface. Of potential interest is that almost all of the personnel in our lab/clinical group are ethnic-minorities including post-docs (e.g., Spain), graduate students (e.g., Honduras) and undergraduates (e.g., African-American).
In 2011, I received APA’s Distinguished Award for Independent Practice. Together with my work on the AMA Current Procedural Terminology panel (with the same voting power as Medicare), I have been committed to expanding the role of psychology in healthcare. The most recent example is the introduction of 22 new psychotherapy codes that encapsulates both levels of complexity and the expanded role and evidence of psychotherapy.
Again, though not I am member of division 17, my personal, academic and professional qualifications, aspirations and accomplishments reflects the division’s mission and focus. Together we can make APA more attentive and responsive to the mission of the Society for Counseling Psychology and to those we seek to serve.2. Briefly describe the importance of SCP’s endorsement in your campaign.
The Society of Counseling Psychology has and continues to represent not only a powerful and historical constituency but, also, one that parallels my own thinking and activities. In some ways not getting your endorsement would reflect a serious disappointment that I have not been able to connect my own thinking and career to similarly minded members of APA.
Further, one of the members of my “cabinet” and one of my good friends is Teresa LaFromboise. She has encouraged me from the start to understand the challenges facing counseling psychology in a difficult professional and academic environment. The long history and many contributions of this specialty warrant protection and enhancement of counseling in mission “creep” situations, including APAPO’s mission. We must do everything possible to insure the future of counseling psychology in our rapidly evolving health care and academic climate.
I appreciate that one of the candidates is a dearly beloved past-president of the division and the other has been one of your elder leaders. In many ways, APA is very fortunate to have three candidates with a strong ethnic-minority and social justice focus. However, I would like to add that I received the largest number of nominations.
Your endorsement, in any fashion possible, would greatly enhance the possibility that our goals would be accomplished. As I have previously stated, the mission and scope of the division matches my personal and professional life.
3. If elected as APA president, briefly discuss how your presidential initiative(s) might reflect the mission, activities, and values of Counseling Psychology and of the Society.
If elected president of APA I would still make Spanish the official language of psychology. Interestingly, there are more Spanish speaking psychologists in Spain, per capita, than in the US (I have been a Visiting Professor of Psychology at the Universidad de Granada in Spain for the last 26 years).
More seriously, more information about my initiates can be found at www.puenteforpresident.com. However, here are several of importance to the Society:
1) Integrated health care is our future and psychology’s entry into being critical in guiding healthcare. Towards that end I have similarly focused on increasing psychology’s presence in the healthcare arena. Of most recent interest is my request and eventual approval by AMA and CMS to develop integrative health care codes in which behavior is critical in the delivery of healthcare. (Note: I am on the AMA CPT panel which helps determine what healthcare is done in America).
2) Diversity and empowerment has been central to several of my activities most notably educational. At my university I founded the Centro Hispano and we now have the second largest number of Hispanics in the UNC 16 campus system. I have trained graduate students and postdocs from 13 different countries, most notably Spanish speaking ones. This effort will be transferred to APA by reviving some prior successful initiatives (e.g., reviving several of Dick Suinn’s presidential ideas- I was on his “kitchen cabinet”).
3) I would continue to emphasize multiculturalism, feminism and social justice. They have been part of my life and have been and will continue to be integrated into my leadership. I will establish a kitchen cabinet that will reflect people and ideas similar to that of the Society. In addition, one of the themes of the conference during which I will be president will reflect the role of culture and ethnicity in psychology.
Though the preceding are illustrations of my history as a person and as a psychologist. Whereas I have specific initiatives, the most important thing I could mention is that a person with similar values as the society would be in APA’s highest leadership position.
An APA for all members!
APA PO Puente
Antonio E. Puente
APA PO Questions
06.17.151. What do you believe are the most important opportunities and challenges facing professional practice in the next three to five years, and how would you address them?For the last year I have been involved in surveying approximately 10,000 APA members to gauge ranking of the professional challenges. Last year’s survey revealed that the top four challenges (in order of importance) to respondents:
1. Protect reimbursement.
2. Protect the doctoral degree as a standard for psychology licensure.
3. Address health care reform.
4. Protect and enhance psychology’s scope of practice.
This year’s survey indicated that the most important challenge is inclusion of psychologist in the Medicare’s definition of physician. The second challenge is how to get reimbursed for the provision of integrated care.
As to opportunities, they are plentiful. In another survey from last year the following opportunities were outlined based on prior presidential initiatives. They included:
1. Translating psychological science for the public.
2. Educating and engaging the next generation of psychologists.
3. Provide psychological services to the military.
4. Advancing psychological knowledge.
This year integrating psychology into the larger healthcare system was by far the most important opportunity, which would most likely be spearheaded by current APA efforts to obtain reimbursement for such activities. This integration of psychological services would 1) increase efficiency, 2) decrease costs and, 3) expand the scope of psychological practice.
2. What would you identify as your priorities for ensuring that psychologists will have a pivotal role, front and center, in leading and implementing health care reform?
I see the priorities as being at three levels: federal, state and local. Accordingly,
my priorities are as follows:
1) Include psychologist in the Medicare definition of physician.
2) Protect and expand the scope of practice of psychology including but not limited to obtaining a CPT code for integrative care. We should consider the examination of current Health and Behavior as well as testing codes (especially reimbursement of integration of data and feedback to the client).
3) State by state analysis and support for the expansion of Medicaid programs. The weakest link will set the lowest bar for others to follow. The “fight” has shifted from Washington, D.C. to state capitals.
4) Once the programs outlined in #3 are set, the focus will shift with how ACO will be developed at regional and local levels.
5) Train psychologists to become more engaged advocates through implementation of advocacy programs such as 360 Degree Advocacy (Karen Postal and IOPC).
6) Help APA members understand the structure of APA PO and their expansive and critical activities for the practice of psychology.
For further information here are some websites for your consideration:
APA DIVISION 31
STATE, PROVINCIAL & TERRITORIAL
PSYCHOLOGICAL ASSOCIATION AFFAIRS
APA PRESIDENT CANDIDATE QUESTIONNAIRE
province, or territory?
If so, please list where and when you’ve held memberships:
- Are you a member of the psychological association of your state?
I have been a member of the North Carolina Psychological Association since 1982. And I am a member of NCPA’s Division of Independent Professional Practice since its founding in 1989.
- What offices or positions have you held in your SPTA, and when?
Chair and Member, Continuing Education Committee – most of the 1980s and early 1990s
Member, Long Range Planning Committee 2007 to present
NCPA Executive Committee and Board of Directors
Founding President, North Carolina Psychological Foundation 1991 to 2005
which have strengthened your SPTA.
- Describe your activities and accomplishments at the local/SPTA level
Convention/Continuing Education: Help develop the format and strategies used in meetings that have lasted 30 years (e.g., big names, hot topics, creative financial arrangements with speakers). My students have regularly presented at our spring conference (approximately 2-3 posters per year).
Workshops: Have given a workshop (pro-bono) at NCPA once every 5 years (or more) for over 30 years. This includes the undergraduate conference.
Committee: Served as advisor or member on several committees (e.g., Insurance, Legislative, Professional Affairs) as well as advising the Division of Independent Professional Practice.
Foundation: I helped establish the North Carolina Psychological Foundation in 1991 and eventually helped get NCPA its permanent home including a campaign that gained a gift of $300,000 and raised an additional $75,000 from the NCPA membership. Helped establish the Foundation’s annual undergraduate conference that is in its 22nd
strengthened or benefited SPTAs.
- Describe your activities on the national/APA level which have
I am a believer of- dream nationally, act locally. APA cannot function without SPTAs and vice versa especially with the advent of ACA. Towards that end I have spent the last 25 years working first as an advisor to the AMA Current Procedural Terminology Panel (15 years) and now as one of 17 members of the voting panel (including representatives from Medicare, BC/BS, etc.). In turn, I have given over 100 workshops over the years to local and state groups/associations to educate them as to these policies.
Of note is that I have been involved in APA for over 30 years being a member or chair of ? committees and Boards as well as several representing APA in several other ways (e.g., Medicare’s Payment Advisory Committee).
Finally, I am a member and fellow of Division 31.
- What do you perceive as being the issues of greatest concern to SPTAs, as organizations?
As I travel throughout the states and as I hear from our own organization, membership and finances appear to be the major concerns. The greatest irritant, and chief concern, is the fact that many psychologists benefit from the work done by SPTA but do not support them especially by joining them. Of concern is the low number of ECPs that are engaged as members and leaders of these organizations. Finally, increasing concern about the states economic viability in light of decreasing membership and convergence attending.
- What do you perceive as being issues of greatest concern to members of SPTAs?
The basic message that I hear over and over again as I travel to SPTAs is that APA has lost its direction and connection to its membership (even before the Hoffman report). APA has become a professional corporation and not a membership drive organization. “My voice is not heard, my ideas do not matter...my work is of little consequence” are samples of comments that my colleagues in the trenches share.
The other clear message is that members do not believe APA is doing enough regarding reimbursement rates – whether accurate or not. This needs to change in both perception and action.
In addition, though not frequently voiced, is that healthcare policy has shifted from the federal level to the state level. The ACA will be interpreted at state capitals and lowest common denominator will become the standard for other states. In turn, this will become the standard at the national level. A loss in one state capital will be a loss for all.
- If elected to the APA Presidency, what would you do to address these
- The APA PO either needs to be reorganized or become more transparent AND member driven.
- The state office of APAPO will need a new direction, possibly leadership.
- An office will be set up within APA PO to coordinate efforts across all states in the implementation of ACA.
- An external review should be immediately pursued to determine how APA could become more transparent, accountable and effective.
- I would form a task force of state leaders together with representatives from CESPPA, including Sally Cameron, to advise me on how to accomplish the preceding, especially #2.
address the affairs of state, provincial, and territorial psychological
- Please add any comments you’d like which are not elicited above that
During this year’s campaign I will have spoken at approximately 20 state associations. From Nevada to Maine, from Illinois to Florida and the spirit, camaraderie and efficiency seen at this state association is, in a nutshell, what APA is missing.
NCPA is where it all began for me, it is a model of how APA should function and it is my home.
What do you feel should be the priority for APA in the next 12 months related to the findings of the independent review (Hoffman Report)?
After 30 years of leadership and service with the American Psychological Association and other professional and scientific organizations, I seek to re-establish the preeminent role of APA, holding true to its long, rich history.
I am deeply saddened by recent events and greatly appreciate those who have been a minority voice and as well as colleagues who are working diligently toward a reasoned and constructive solution.
A particularly unfortunate outcome of the recent revelations is a crisis of confidence in APA by its members and the public.
I believe that from these ashes, the phoenix will rise.
To achieve the rebirth of APA:
- The Independent Review must be considered an important first step in data gathering, problem solving and moving forward. We must bring diverse voices together and identify and execute how to change APA for the better.
- I strongly support the recently adopted resolutions to overhaul the APA Ethical Standards, rules and procedures and to unequivocally prohibit psychologist involvement in torture.
- I believe that an external review of APA is needed to ensure transparency and integrity. In conjunction, APA must shift from being a professional management organization to a membership driven organization.
- An independent ombudsperson (e.g., possibly outside of psychology with organizational leadership experience) should be appointed in order to provide membership input into and concern about APA activities.
- Finally, specific focus must be provided to the selection of a CEO that will lead our organization towards a new future. This will require careful and representative selection of a search committee and consideration of a more extended interim CEO position.
In addition, APA must continue to fulfill the needs of members today as well as in the future. To keep APA moving forward, the programs and services that represent our organization today must meet the growing demands of the education, practice, science and service of psychology.
Significant problems continue to face APA and psychology that need to be addressed now:
- Declining membership in APA and SPTAs.
- Decreasing funding for psychological research.
- Inability for doctoral interns and fellows to be reimbursed for services.
- Most importantly, not being included in the Medicare
definition of physician.
It is time for a new vision and
leadership of psychology. And most of all, it is a time for an APA for all psychology
and the rich diversity we represent.
From professional to forensic settings, from laboratories to classrooms, and from the leadership to the membership, we will have an APA for all members.