THE BREAKERS BREAKING. THE SEAGULLS SQUAWKING
Pat DeLeon, Ph.D.
January 7, 2025
During the Closing Hours of 2024
The last time the Republican Party (GOP) controlled the Senate, House, and Presidency was from January 20, 2017 to January 3, 2019, during which time Donald Trump was President of the United States having being inaugurated on January 20, 2017. With this historical context in mind, the 118th Congress struggled with their Appropriations decisions for the coming year. Although it was not ultimately adopted, the initially crafted bipartisan Continuing Resolution (CR) provided a glimpse into the thinking of several of the authorization committees. Whether these provisions will ultimately become public law is yet to be determined. Nevertheless, there was clear evidence of the growing recognition by both parties in Congress of the applicability and benefits of telehealth care. For example, included in the proposals were express authorities for Expanding Telehealth Services for Federally Qualified Health Centers and Rural Health Clinics with the costs associated with the furnishing of these services to be considered allowable costs for the purposes of the prospective payment system. Delaying the In-person Requirements Under Medicare for Mental Health Services Furnished Through Telehealth and Telecommunications Technology; and, Allowing for the Furnishing of Audio-Only Telehealth Services. Also included was authority for Extending the Use of Telehealth to Conduct Face-to-Face Encounters Prior to Recertification of Eligibility for Hospice Care.
Also in the proffered CR was a provision, which another committee proposed, for the establishment of an Older Americans Tribal Advisory Committee – “In addition to other methods of government-to-government consultation between the Administration and Indian Tribes and conferring with organizations representing Native Hawaiians, the Assistant Secretary shall establish an advisory committee, to be known as the ‘Older Americans Tribal Advisory Committee’ to provide advice and guidance… on matters relating to the needs of older individuals who are Native Americans and implementation of related programs and activities under this Act.” This new Committee would be composed of 11 voting, non-Federal members, including geographically diverse individuals with expertise on the range of issues affecting Indian Tribes, organizations representing Native Hawaiians, and older individuals who are Native Americans. Not less than one Alaskan Native and one Native Hawaiian would be appointed to the Committee.
On December 23, 2024, President Biden signed the Servicemember Quality of Life Improvement and National Defense Authorization Act for FY 2025. This was the 64th consecutive year in which the Defense authorization legislation was signed into public law, notwithstanding bipartisan concerns expressed after the Speaker of the House of Representatives included a particularly controversial provision after the conferees had come to an agreement. Although the authorization legislation did not include any specific provisions that would appear to be directly targeted towards the behavioral/ mental health professions, there were a number of relevant issues which were addressed in the final conference report.
For example, in exploring Psychological Performance Training for high-stress environments, the conferees noted: “We understand that long-term exposure to high-stress environments can leave servicemembers in suboptimal performance states – possibly leading to compromised performance abilities and negative behaviors. The Air Force trains on the development of proactive psychological performance skills and strategies for psychological flexibility and mental strengths. We recognize potential benefits to training to develop and maintain psychological performance skills and mental resilience. We, therefore, direct the Secretary of the Air Force to provide a briefing, not later than April 1, 2025, to the Committees on Armed Services of the Senate and the House of Representatives on the following: (1) Efforts conducted previously or currently at Air Force Global Strike Command and Air Force Air Mobility Command to train airmen in psychological health and performance; (2) Outcomes of such training efforts – to include any relevant airmen feedback; (3) Costs associated with providing such training services; (4) Efforts, if any, to budget and plan for expanding psychological performance skill training; and (5) Any other relevant matters that the Secretary determines appropriate.”
The conference agreement further included a provision which would require the Secretary of Defense to monitor access standards for specialty behavioral health care. And, in the event that the Secretary determines that behavioral health care access in a state does not meet or exceed prescribed access standards for more than 12 consecutive months, the Secretary would be required to expand health care accreditation standards in that state to include credentials issued by state-level organizations. Although the conferees did not include a House proposed provision that would have required the Secretaries of the military departments to review and certify suicide prevention policies each year as well as update online contact information, they did expressly note that the conference report for the previous year directed the Secretary of Defense to review publicized information on suicide prevention and behavioral health and to provide a briefing, not later than June 1, 2025, to the Committees on the results of such review.
Impressively, the conferees also noted that in August, 2022, the Armed Services Committees had received a report from the Department that “demonstrated consistent high quality of perinatal health care services in the direct care component of the military health system. According to the report, the pregnancy-related mortality ratio in such component was 2.91 deaths per 100,000 live births as compared to 23.80 deaths per 100,000 live births in civilian hospitals. Furthermore, we note that the military health system collaborates with external organizations, such as the Leapfrog Group, to adopt leading practices to decrease maternal mortality further.”
Pleasant Reflections
Over the years, one of the most impressive interprofessional training and clinical initiatives that we have seen, has been the Medical-Legal Partnership for Children in Hawaii (MLPC-HI) directed by Dina Shek. As APA CEO Arthur Evans steadily moves organized psychology towards systematically embracing a population-based, public health orientation, Dina’s underlying vision captures the essence of a comprehensive and truly holistic, patient (client-) oriented health system aggressively addressing the psychosocial-cultural elements of quality health care.
Highlights of Dina’s annual report: “We are pleased to share some year-end highlights from an exciting 2024 at the MLPC-HI, a project of the University of Hawaii’s William S. Richardson School of Law (WSRSL). As we take this moment of reflection and gratitude, we also brace ourselves for more hard work to come. We invite you to join us and support the team as we enter 2025 committed to realizing our core values by centering racial justice, acting collaboratively, and uplifting community power.
“We launched a new MLPC-HI site with the Kapi’olani Medical Center for Women and Children, Hawaii’s only pediatric specialty hospital! Our staff attorney Ashley Kaono (WSRSL ’20) is embedded with the hospital social work team, and together they have already maintained critical benefits, improved housing conditions, and reduced hospital stays for children with disabilities. The University of Hawaii News featured our celebration. We completed our 15th year of partnership with our anchor site at Kokua Kalihi Valley (KKV), now staffed by our staff attorney Fernando Cosio (WSRSL ’18). To date, we have handled about 2,000 legal case matters at KKV, supporting housing, financial, and family stability. We also support public housing residents, Micronesian communities, and other migrant/immigrant communities through extensive systemic advocacy work. [Earlier, when Mary Wakefield arranged for KKV CEO David Derauf to attend a special Obama Administration White House event, Dina reflected that they were truly having a national impact.]
“Our Community & Policy Advocate Philios Uruman organized and led our staff and law students in Micronesian community advocacy work including Maui outreach for Micronesian survivors of the Lahaina wildfires; co-hosting a COFA [Compacts of Free Association] Benefits Update Town Hall with the Hawai’i Coalition for Immigrant Rights that featured Meghan O’Connor from the Office of Senator Mazie Hirono (D-HI); and meeting with His Excellency Wesley W. Simina (WSRSL ’88), President of the Federated States of Micronesia. Deja Ostrowski (WSRSL ’10) was elevated to Managing Attorney with support from a new Medical-Legal Partnership Plus federal grant program. With the support of Aimee Grace, Director of the UH Office of Strategic Health Initiatives, we were one of eight grantees selected for this national grant and in February we hosted a site visit with the Director of the Office of Community Services under the Administration For Families & Children, HHS.
“Personally, I recently co-authored an essay in the Yale Law Journal Forum titled ‘Bind Us Together: Coalition Public Policy Advocacy in Medical-legal Partnerships’ Our team also collaborated with a University of Hawaii librarian to publish an article in the Journal of Law, Medicine & Ethics titled ‘Quantifying ‘Community Power’ and ‘Racial Justice’ in the Medical-Legal Partnership Literature’ which was published online earlier this year.
“As we head into the new year, our MLPC-HI team remains committed to ensuring a safe and just future for all. Rebecca Solnit reminds us in the moment. ‘Remember what you love. Remember what loves you. Remember in this tide of hate what love is. The pain you feel is because of what you love.’ We are so grateful to all of you for your partnership and support of our work. Many thanks and Happy Holidays!” [For information regarding Dina’s MLPC-HI program, see [https://law.hawaii.edu/academics/medical-legal-partnership/] and for information about the MLP national organization see [https://medical-legalpartnership.org].
Steady Maturation
The waves heralding steady movement away from our traditional symptom-oriented, individual patient/silo-based health care system continue to expand, as constantly urged by the National Academy of Medicine and other health policy think tanks. What is envisioned at the conceptual level is a considerably broader and more comprehensive approach which takes into account historical structural racial, economic, and environmental barriers, that unfortunately have led to demonstrable and highly significant Health Disparities. From the warm beaches of Hawaii and its Medical-Legal Partnership for Children to the rugged coasts of Maine, the growing signs of change are evident. In October, Maine Psychological Association CEO Randy Moser urged his membership to attend their annual convention and “Explore how integrating behavioral health and primary care can revolutionize treatment for rural communities. Hear from national experts like Arthur C. Evans and Maine’s own Diana Prescott as they share cutting-edge strategies for addressing mental health and substance use disorders, tailored specifically for rural populations. Don’t miss this chance to learn how integrated care can improve patient outcomes and build healthier communities!” “To the seaside, whoa-oh. By the beautiful sea” (From Sweeney Todd).” Aloha,
Pat DeLeon, former APA President – Division 29 – January, 2025