August 24th, 2012

States with privileges provide feedback

Since 2002, when New Mexico became the first state to grant prescription privileges to psychologists, only Louisiana has followed suit.

But Dan Abrahamson, Ph.D., assistant executive director for state advocacy for the American Psychological Association, says an average of seven states over the past decade have introduced legislation. He expects a similar number to seek privileges in 2013. “There are new states coming on and getting involved all the time,” he says.

Oregon (2010) and Hawaii (2007) successfully passed bills through the legislature, only to have them vetoed by the governor.

“With all the effort we’ve put into supporting this initiative, it’s heartening that the states are still very committed to it and working in synergy with us,” Abrahamson says.

To help states build the capacity to pursue legislation, the APA has compiled resources and created a prescriptive authority training program. APA developed an approved curriculum for training psychologists to prescribe and established a committee to evaluate applications for programs that want to be designated. Three programs currently have APA designation – California School of Professional Psychology (San Francisco), Fairleigh Dickinson University (N.J.) and the Southwestern Institute for the Advancement of Psychotherapy/New Mexico State University.

In New Mexico, Elaine S. LeVine, Ph.D., ABMP, says 33 psychologists have been licensed with prescriptive authority.

LeVine, a prescribing psychologist and training director of masters in psychopharmacology at New Mexico State University, helped spearhead the 2002 effort and is pleased with the results.

“It’s not just prescribing; it’s the integrated healthcare aspect. Its how the training has opened up my understanding to better differentiate medical conditions from psychological conditions. Some of my most important work has been identifying things like, ‘does someone have a seizure disorder rather than a psychological disorder?’”

She says primary care physicians work closely with prescribing psychologists. In addition, LeVine doesn’t think psychiatrists feel threatened by the authority but see it as a means to serve an “underserved” population. “I think we’re really fulfilling a need. Our prescribers are all over the state. Our opponents said we would only be in the cities, but that isn’t really accurate.”

LeVine sees value in her training not only to prescribe, but to “unprescribe.” When she served as a medication manager at a family clinic, she says 80 percent of her practice involved taking children off of multiple medications when psychological or social interventions hadn’t been tried. “They were basically being sedated.”

When prescribing for patients, she says her first approach is always psychological intervention.

In Louisiana, trained psychologists were granted prescription privileges in 2004 and are legally referred to as medical psychologists (MPs). Under the law, MPs were required to work collaboratively with the patient’s physician when prescribing medication.

However, in 2009, the Medical Psychology Practice Act was passed that transferred licensure of MPs from the State Board of Examiners of Psychologists to the State Board of Medical Examiners while also providing for the independent practice of “Advanced Practice Medical Psychologists” for patients under certain circumstances. These circumstances include those patients who are referred by their primary care or attending physician, according to Cathy Orman Castille, Ph.D., MP, advanced practice medical psychologist and president of the Louisiana Academy of Medical Psychologists. Castille says advanced practice medical psychologists are MPs who have acquired additional qualifications.   There are nearly 70 MPs in Louisiana, she said.

“Without exception, the feedback from prescribing psychologists has been extremely positive,” Castille says. “There are many benefits, but primarily, the services help to fill a huge gap in the availability of psychiatric services across the state.” MPs work and prescribe in a variety of settings such as private and state-operated facilities, clinics, hospitals and prisons.

Bryan J. Gros, Ph.D., a licensed psychologist and president of the Louisiana Psychological Association, says the LPA has a long history of support for prescription privileges for psychologists although it doesn’t have an official position. Gros says the “LPA does support prescription privileges for psychologists who are properly trained according to Louisiana statute and whose practice of psychology is regulated by our state psychology licensing board.”

Gros makes the distinction that support is for the practice of psychology by prescribing psychologists regulated by the state psychology licensing board. Since the 2009 legislation, the medical board regulates MPs not only for the practice of prescribing, but for the practice of psychology such as psychotherapy and psychological testing. MPs may or may not choose to retain a psychology license.

Gros cautions states considering prescription privileges for psychologists to avoid licensing and regulation of the practice of psychology by a medical board. “It’s caused some division [within LPA].” By no means do we think that anyone intended this to be controversial but this had led to unintended consequences.”

Overall, Gros adds, privileges have been positive for both clients and medical psychologists.

By Pamela Berard

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