Prescribing psychologists working in the federal system
By Tori DeAngelis
Psychologists have been prescribing in the federal system longer than in the states — since 1994, when the first psychologists graduated from a prescribing psychology (RxP) demonstration project headed by the Department of Defense. Today, approximately 30 psychologists deploy their joint prescribing and clinical skills across a range of federal agencies.
“Opportunities in these settings are growing as the need for well-trained mental health prescribers skyrockets,” says David Shearer, PhD, a prescribing psychologist and director of behavioral health for the family medicine residency at Joint Base Lewis-McChord, one of the Army’s largest military treatment facilities (MTFs).
RxP and the military
A key example is treating military personnel. “The signature injuries of our wars have been traumatic brain injuries and post-traumatic stress disorder, both of which psychologists are uniquely situated to understand, assess and treat,” Shearer says. “Adding the prescribing component to that treatment makes us all the more helpful.” Prescriptive knowledge is also vital in helping patients served by the U.S. Public Health Service (USPHS) and two of its healthcare delivery agencies: the Indian Health Service (IHS) and National Health Service Corps (NHSC), which tend to include members of vulnerable populations living in remote, rural or inner-city areas with few or no psychiatric providers.
Federally based prescribing psychologists are also taking their expertise to the world of telehealth. Bret Moore, PsyD, a prescribing psychologist and deputy director of the Army’s Warrior Resiliency Program, provides telehealth services to soldiers at Army locations that face difficulty in recruiting providers to work on site — two in rural areas and one at Fort Leavenworth’s disciplinary barracks. What started as a pilot program has blossomed into a major service used by thousands of patients each year, he says.
Challenges to prescribing
Remaining issues in the federal system include the need to better educate agency leaders on what prescribing psychologists do, and a call for uniform training requirements, federal prescribers say. At present, each military service has its own set of requirements (Shearer and Moore spell out a proposal for uniform requirements in a 2015 article in The Tablet, a publication of the American Society for the Advancement of Pharmacotherapy.)
“Despite a great track record in the federal system — 20 years with no significant errors — prescribing psychologists continue to face challenges in being hired and in their ability to practice across the full scope of their license,” says Kevin Mc Guinness, PhD, CAPT, USPHS, Ret., a prescribing clinical health psychologist at the Rio Bravo Community Medical Home in El Paso, Texas, and the first licensed medical psychologist to obtain full and independent prescription privileges in the USPHS, including the IHS and NHSC.
To this end, he encourages federally employed prescribers to “educate, educate, educate” appropriate leaders and colleagues.
“The more you develop colleagues who respect and value what you do,” he says, “the more likely you are to have them on your side.”
Read more about efforts to obtain prescription privileges for psychologists in the Fall 2017 Good Practice magazine article, “Prescriptive Authority: Renewed action in the states.” Good Practice magazine is free for all members of the APA Practice Organization. To join, visit this page.
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