Episode 10

Dr. Evans, the new CEO of the American Psychological Association, continues his lifelong commitment to the underserved and ensuring that effective, high-quality healthcare is accessible to all.

About the expert: Arthur C. Evans, PhD

Dr. Arthur C. EvansPolicymaker, clinical and community psychologist, healthcare innovator, Arthur C. Evans Jr., PhD, is the new CEO of the American Psychological Association (APA) and just completed twelve years as Commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Service (DBHIDS). The transformation of the Philadelphia service system has improved outcomes for people and saved millions of dollars that the city has reinvested in other community-based services.

Dr. Evans brought a new approach to his agency’s system of serving a wide range of individuals with complex needs. The transformation of the $1 billion Philadelphia system into a recovery-oriented, outcomes-focused system of care has leaned heavily on public health strategies that contribute to better population health. In addition, he has emphasized data-driven approaches to improve system performance.

Dr. Evans has been recognized nationally for his work in behavioral healthcare policy and the transformation of service delivery systems. In 2015 he was recognized by the White House as an "Advocate for Action" by the Office of National Drug Control Policy. In 2013 he received the American Medical Association’s top government service award in health care, the Dr. Nathan Davis Award for Outstanding Government Service. Dr. Evans is also regarded as a strong mental health advocate and was recognized by Faces and Voices of Recovery with the Lisa Mojer-Torres Award.

His future at the APA will continue his lifelong commitment to serving people who are underserved and ensuring that effective, high-quality healthcare is accessible to all.

Transcript

Hannah Calkins: Hello and welcome back to Progress Notes, a podcast keeping tabs on the practice of psychology. I’m Hannah Calkins. APA employees have had lots of time to get to know Dr. Arthur Evans, who took the helm as CEO of APA in March. But we wanted to introduce him to you—and give you a chance to hear about his vision for the future of psychology and your role in that future. So, I sat down with Dr. Evans to talk about it. Here’s our conversation.

Hannah Calkins: Thank you for stopping by today to talk to us at Progress Notes! All of these questions, for the most part, were submitting by CAPP, so you’re hearing directly from them about what they want to know from you. Before we get too far into that, and talking about your vision for APA and for psychologists and psychology, tell us a little about yourself—introduce yourself, and talk about your professional background and experience.

Arthur Evans: Sure. So, thank you for inviting me; I’m very excited to be here! I grew up in Florida. My family was—my dad was in the military, so I grew up in a military family. And when we came back from Japan, where I was from the age up to about the age of 5—we settled in Central Florida—a little town called Melbourne, where I grew up. And there I was in music, and actually majored in music, and eventually changed over to psychology. The first program I was in was experimental psychology. I have a master’s in experimental psychology. So my early training was much more in the research area. I went to University of Maryland for my doctorate, which at the time was a clinical and community psychology program. So I like to think of myself as a broadly trained psychologist who has worked in research, doing human factors work; my master’s thesis was in computer-assisted instruction; but also, spent most of my career doing service delivery and policy work in mental health service delivery. I spent time in Connecticut as deputy commissioner there for mental health and addiction services, and spent the past twelve years prior to coming to APA as the commissioner for behavioral health in Philadelphia. So, I’ve had a really great career; I’ve had a chance to work with all kinds of psychologists; I love our discipline; I love our profession; and I’m just thrilled to be here at APA.

Hannah Calkins: That’s a great launching pad for the next question, which is: what excites you most about being CEO?

Arthur Evans: Well, I think APA is a great organization. I can’t tell you how honored I am to be the CEO. And on top of that, I get to come to work every day with a great group of professionals who are not only talented but are very passionate about our discipline. In addition to that, we have I think a phenomenal group of people who are members of APA, and I’ve had a chance not only in this role but prior to be in this role of just interacting with people who again are very talented, but also very committed and passionate about the work that we do. And I think that most of the work we do as psychologists really is social justice work—it’s about trying to make the world better for anyone who goes through the trouble of getting a PhD or a PsyD…You’re spending pretty much a decade of your life getting trained. And I think that’s a special group of people, because we’re getting trained not to come out and be millionaires and billionaires but we’re coming out spending a decade of our lives to serve other people. So I think we have a very special group of people in our association, and I’m thrilled to be working with folks. In addition to just the people I work with in this role, I’m very interested and excited about the potential for APA to do even more work in in the area of how we serve the community. How do we, as psychologists, how do we position our profession—our discipline—in such a way that we can be optimally effective, that we can practice to the full scope of our training? I’m also very interested in how do we give our services away in addition to making sure that we are a viable profession and discipline. So, I think all of those things kind of for me fit together and really lead to, for me, a vision of APA that’s dynamic, that’s viable, that is making a huge impact in our communities.

Hannah Calkins: So then your last role in Philadelphia as the Commissioner of the Department Behavioral Health and disAbilities there will clearly inform what you just talked about. So can you talk a little bit more about how this role at APA compares to that role, or differs from it?

Arthur Evans: Well, I think there are a lot of similarities in terms of management. I think there are a lot of similarities in terms of complexity. I think there are similarities in terms of the importance of vision and building consensus with stakeholders. So those things are very similar. I think what’s different is that in my role as Commissioner for Behavioral Health, a lot of the decisions I was making on a day-to-day basis were life-and-death decisions. It was, if we do this, we can help more people who might be homeless, or children who might be abused or neglected, or people who might have an anxiety disorder and are just trying to go to work every day. In this role, I think the work is one step or two steps removed from that. A lot of the things we do in terms of developing practice guidelines for the field, a lot of the work we do in terms of developing standards and accreditation, all of those things help in terms of addressing those issues, but we’re a couple of steps removed. I think the other difference is APA, because we’re a membership association, it’s really, really important to build consensus around ideas. In my previous position, if the mayor said, “We’re going to do X,” we pretty much did X, right? Or when I worked for the governor in Connecticut, it was if the governor wanted us to do Y, we did Y. At APA, it’s much more, how do we build consensus around ideas and how do we build momentum around ideas and principles, and then move forward. So, there are clearly some similarities, but also some differences.

Hannah Calkins: So then shifting to psychologists, and specifically practicing psychologists, who are of course our listeners, what do you see as the greatest opportunities for practicing psychologists in the next five to ten years?

Arthur Evans: Well, I think that the greatest opportunity is for us as psychologists to practice to the full scope of our training. I think that many practitioners practice very narrowly. And so we may spend 90% of our time only doing psychotherapy. Psychotherapy’s very important; I’ve spent my whole career figuring out how to get psychotherapy to individuals, and to pay for services and to structure programs, but for us as psychologists, we have a much broader set of skills. And I think the way the health care environment is changing, I think there are going to be many more opportunities for us to use the full breadth of our skills. For example, all of us are trained—you know, we have a dissertation and we’ve done research. Those skills turn out to be really important when you’re trying to develop new interventions in communities. We have the ability to evaluate the work that we do. There are lot of things we do as psychologists that are not necessarily the skill set that other mental health providers and practitioners have. I think the question for us is, are we going to continue to practice narrowly, or are we going to use the full breadth of our skills? One of the things I’m personally very interested in is the whole notion of population health, which is an emerging concept that says that our health care system should be about, how do we raise the health status of everyone in the community, as opposed to only focusing on people after they are ill? So it means there are many more opportunities to intervene early; to put more emphasis on prevention; to put more emphasis on educating the public about on mental health—and health for that matter—as well as using our skills to help make service systems operate more effectively; and for communities, and for entities and institutions in communities, to better address mental health issues. So I just think there’s a big landscape out there. I’m very excited to see what a lot of psychologists are doing, and I’m very interested in seeing how we can spread that within a broader footprint within our field.

Hannah Calkins: So, then, those are the opportunities—and the answer might be the same for this side of it—but what are the challenges for the next five or ten years for practicing psychologists?

Arthur Evans: Well, certainly, one of the challenges is the converse of what I just said, which is, if we practice too narrowly, I think we run the risk of being obsolete. Because there are a lot of practitioners out there who can provide psychotherapy, and with the advent and the increasing emphasis on evidence-based treatment approaches, I think a lot of those practitioners can develop pretty effective interventions and pretty effective services. And so, again, if we’re only doing psychotherapy, I think we run the risk of really not positioning ourselves in the most viable way. I also think that we have to build our advocacy capacity. If you look at the amount of money that psychologists raise relative to other fields—take nursing, for example—we’re way at the bottom of the pack. And so part of the cultural shift we have to make within our field is to make giving—political giving—just a part of our professional identity, part of our professional obligation. I think that will go a long way in helping us, APA in particular, to be in a position to fight for psychology, to fight for rates, to do the legal battles that we need to do so that psychologists can have a viable career.

Hannah Calkins: This is related. How can APA, or practicing psychologists anywhere, demonstrate the value of psychologists, given increasing competition from other behavioral health providers?

Arthur Evans: We need to be able to empirically show how using a psychologist results in better outcomes. And I was a policy maker, a public payer, for many years, so I was on the paying side of services for many years—you don’t need a lot of very sophisticated data. You don’t need to do a lot of randomized, controlled studies to figure out whether you’re doing a better job than maybe some other disciplines or maybe that your services are effective. But can you demonstrate that because you’ve worked with this cohort of people that you have shorter stays in the hospital; you have better continuity of care; that people are able to get back to earlier? I mean, simple data collection can go a long way in demonstrating that you’re offering a very important, valuable service to the public and I think we have to build that into our culture of what it means to be a practitioner. It’s not just enough to deliver the service; we need to deliver the service and then brag on ourselves a little bit. Show the public: here’s why it’s really important for you to use psychologists.

Hannah Calkins: Now a question very dear to Practice Organization members: Psychologists’ living wages have been steady or declining now for over a decade, while reimbursements for other health professions have increased. How can this reimbursement challenge be turned around and improved?

Arthur Evans: Sure, well, it goes back to the issue of political giving. We have to, as a field, understand that policy makers—the people making the decisions—have hundreds of people—thousands of people—who are coming to them for their attention. And if we want our issues to be heard and understood, we have to have a viable political strategy, which means we have to give politically. But we also have to be willing to make phone calls, we have to be willing to go to political fundraisers; we have to do those kinds of things, because at the end of the day, that’s how decisions get made. And if you look at any discipline, profession, that’s doing well, that’s what they do. There’s not one that is doing well that you can point to that doesn’t have a very strong political strategy. So, there’s just no way around that. We have to do that. And the good news is that we have the infrastructure within APA; we’re doing some things to look at how we can reorganize APA so that we’re much more effective at that, but at the end of the day we need members to be willing to pick up the phone, make phone calls, and make sure that their congressional and state legislators know who they are, know what services they provide, and I think that’s how we get it done.

Hannah Calkins: Earlier you mentioned psychologists needing to kind of dig in and tap in to their broader skill sets. What advice to you have for independent practitioners who are trying to adapt to the changing marketplace, particularly with respect to integrated care?

Arthur Evans: Sure. So I had a private practice for many years, and the way we set up my private practice— I was in private practice for over a decade—the way we set our private practice up, was that we did consulting and training. And it turns out that that combination and providing clinical services, providing consultative services to the community, and then offering training services, was a really powerful mix. And we were very well-known in our community and we were called in as mental health experts in a variety of settings. And think that’s kind of a conceptual shift that I think it’s important for us to make. So, rather than only viewing ourselves as practitioners, to view ourselves as mental health experts who can do a variety of things, including providing services but also consulting to systems and to organizations. So if I were in private practice today, I would really exploit that skill set. I would look at organizations to which I could consult. The reality is that most institutions in our communities are struggling with mental health and substance use issues. They don’t know how to deal with them. And what we take for granted in terms of our training can be very valuable to the local child welfare agency, for example, or even the library. The typical urban library, public library, you go into and talk to the librarians—they’re dealing with people who have mental health challenges all the time. So, small consultations like that begin to raise the visibility of who we are, the expertise that we have, and I think it heightens the value that the community sees in terms of what we bring as a field.

Hannah Calkins: I appreciated what you said earlier about social justice being at the core of what practicing psychologists do. And so related to that, health disparities and equal access to treatment, for minorities in particular, continues to be problematic. How can psychologists best address these inequities?

Arthur Evans: Well, I think we have to work on multiple fronts. We have to make sure we have people in the pipeline who are from the affected communities because those individuals not only have a commitment but they have an understanding that when paired with their formal training can be very effective and powerful. I think that we need to make sure that communities have access to services, so our political advocacy around that is very important. APA took a very strong stand on the Affordable Care Act, not because we were so interested in that particular act but we were very concerned about people losing their health care. And so if Congress could have developed a different set of legislation, or legislation that ensured that a similar amount or more people had health coverage, we would’ve been fine with that. We just wanted to make sure that people had access to care and that there weren’t erosions in access to mental health services. So, that advocacy, I think, generic advocacy is really important because those things disproportionately hurt and affect communities of color, rural communities—which I’m very concerned about; a lot of the policies happening that were proposed in Congress I think would’ve had a really devastating impact on some of our rural communities, exacerbating disparities in those communities, and so that advocacy is very important. I also think it’s important for us as psychologists—you know, I mentioned giving our services away. We’re partnering with Barbara Van Dahlen’s organization, Give an Hour, and the whole idea of that is, historically, that effort has been around giving an hour to veterans; it’s now being expanded to giving an hour of your time each week to it could be anyone in the community. And it could even be non-clinical services. So, you as a clinical psychologist, might give an hour to a local recreation center which is serving hundreds of kids from the community, many of whom have social and emotional problems, and given the fact that you are consulting or perhaps training staff, you could make a huge difference in the social and emotional health of these children. And I’ve actually seen that, where when you train people who are working with children, it can have a huge impact on their social and emotional health, and so those are just some of the ways we as psychologists can help to reduce disparities in our community.

Hannah Calkins: Great. And one last question. The people are dying to know: what do you do for work-life balance as a psychologist, given your demanding schedule?

Arthur Evans: I don’t have work-life balance! I’m working on that. Actually, there are a few things I like to do. I actually like to barbeque, so I have an apartment that’s a few blocks from APA so I walk to work every day and it’s a great apartment complex and they have a barbecue pit so, you know, on the weekends I do that. I like to travel and see new places, so one of the things I try do—the job requires a fair amount of travel, so I try to carve out a little bit of time on those trips to see the sights because I just like to that, experience new food. I love music, so as I said as a music major and I still love music. So, you might find me at a concert listening to Shostakovich and Mahler, or you might hear me listening to Shirley Caesar and gospel music, or jazz music, or Chicago—Chicago the orchestra or the group, I like either one; actually Chicago is one of my favorite groups. So, I like a wide variety of music, and just entertaining. So, I have a few things I try to do and I work a lot of hours, and because I love the work, I don’t mind that; but I also try to get a few hours to some of these other things.

Hannah Calkins: Very well-rounded! Well, that’s all we have, so thank you so much for joining us today.

Arthur Evans: Thank you for inviting me, and I look forward to meeting many more of our members out there.

Hannah Calkins: We hope you’re inspired and excited by Dr. Evans’ vision for APA and for psychology. For more from Dr. Evans, follow him on Twitter @ArthurCEvans, and don’t miss his column in our magazine, Good Practice. The next issue will be out in February.

As always, thanks for listening to Progress Notes, a podcast keeping tabs on the practice of psychology. I’m Hannah Calkins, and this episode was produced by me with help from Jewel Edwards-Ashman. Our theme music is “Cradle Rock” by Blue Dot Sessions. Next month, tune back in to learn how psychologists are bringing value to primary care settings.

Christopher Hunter, PhD: We know that people are going to see their primary care providers, and we know that people are coming with a whole range of biopsychosocial difficulties that are impacting how they function, what their symptoms are, or perpetuating a variety of different medical conditions. The chance to be able to interact with those folks and to work with a primary care team and to have a whole-person focus, for me, has been an incredibly rewarding part of my career.

Hannah Calkins: You can subscribe to Progress Notes on iTunes, and follow us on Twitter @APAPractice.