Keynote Address - 2007 State Leadership Conference
Russ Newman, PhD, JD, Executive Director for Professional Practice
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Welcome to the “new” Washington, where the Democrats have taken control of Congress for the first time in twelve years, ethics reform has been passed by both chambers, a woman has been elected Speaker of the House for the first time in the history of the United States’ Congress and health care reform is back in the news and back on the agenda. Change does, indeed, appear to be in the air.
Of course, psychology has been dealing with a changing landscape for some time. Those of you who attended last year’s State Leadership Conference will recall our discussion of some of those changes, the importance of behavior reform for accomplishing health reform, and our discussion of the trials and tribulations of Paul Revere as he made his way to Lexington on that historic night in 1775. Now, those of you who weren’t here last year have no idea what Paul Revere’s ride has to do with health care reform or with psychology, never mind with our theme this year - Positioning for Change: Expanding Psychology’s Roles, Influence and Value”, but bear with me. The Paul Revere we discussed last year was the protagonist of Malcolm Gladwell’s book “Tipping Point” and clearly demonstrated how a social, word-of-mouth epidemic could be created from a critical mass of small individual actions that cause a tipping point toward significant change. The specific tipping point of interest to us last year was successfully stimulating the public’s realization that health care reform is really about lifestyle and behavior “reform.”
To refresh your memory, last year’s conference, in fact the last two conferences, have capitalized on the growing public awareness in this country that lifestyle, behavior and stress have a significant effect on health and illness. We underscored the central and unique role psychology can play at the intersection of psychological and physical health, sometimes referred to as “mind-body health.” We highlighted our belief that integrating mind and body, behavior and health, and the psychological and the physical, all hold a credible promise of helping to achieve the long sought after goal of improved health with controlled, if not lowered, costs. We emphasized that health promotion and the prevention of illness are critical to healing an ailing health care system all too preoccupied with simply responding to symptoms or chasing after diseases. We concluded that in the absence of any comprehensive health reform plan for the country, a focus on health promotion, prevention, lifestyle and behavior may be just what the doctor ordered.
There is now growing evidence that this tipping point may have occurred, or at least be close by. Large insurance companies are investing real resources to integrate behavioral health care with physical health care. Physicians treating patients with chronic diseases are recognizing the role behavior plays, through co-morbid conditions such as depression, or through treatment compliance. Employers are looking for ways to incentivize healthy behaviors in the workplace. And, a growing movement linked to consumerism in health care is spawning what some say is an entirely new industry built around health promotion and prevention.
But, while there is much to be encouraged about, we are confronted with the cold reality that the benefits of a health and behavior linkage will not be fully realized until the health care system in which it exists changes as well. Simply put, this country’s health care system must become a health system. And, given that what little “system” does exist is integrally tied to curing disease rather than promoting health, this will be no easy task. In fact, I suspect you will hear from our next speaker that more than just reform, what is needed is transformation. The problem he will tell you is beyond reform. The current health care system is too far gone to expect reforming it to do the trick. The number of uninsured continues to rise. We are experiencing an unsustainable increase in costs. There is a growing shortage of health care services and workers, in significant part because reimbursements continue to fall. Availability and affordability of health care is climbing the list of those issues of most concern to consumers. Chronic health problems, such as diabetes and obesity, are on the rise. And, seventy seven million Baby Boomers are fast approaching the age where their need for health care will place enormous strain on an already failing system. The need for creating a new system rather than simply fixing the old one has reached its own tipping point. More about that later.
Perhaps as a sign of the tumultuous times in health care, psychology -- as with most health professions -- spent much of this last year playing defense. Among the most important Practice Directorate accomplishments over the last year was successfully blocking passage of the Health Insurance Marketplace Modernization and Affordability Act. HIMMA, as it is known, was an effort to enable small businesses to band together for the purpose of offering health insurance coverage to employees who have not previously had access to coverage through their employer. Yet, the legislation proposed to achieve its laudable goal by eliminating most state laws related to insurance, including state parity laws, mandated mental health benefits laws, freedom of choice laws and many other consumer protections enacted over the last 30 years. With your help and the technology of the Practice Organization portal, the response to HIMMA was overwhelming and fatal for the bill. Our grassroots network produced close to 19,000 e-mails to the Hill. We lined up the state attorneys general and state insurance commissioners in opposition to HIMMA. And, as co-chair of “Stop HIMMA,” we helped cobble together a coalition of 150 consumer and provider groups. I would be so bold as to say if you look up effective grassroots advocacy in Wikipedia, it might very well list “Stop HIMMA” as a case in point.
Health information technology legislation received considerable attention from the 109th Congress, another laudable legislative goal. Yet, the risk of losing longstanding state level privacy protections in the process of creating a more efficient technologically sophisticated health system was a very real concern. Although no legislation was ultimately enacted by a Congress that left much unfinished, I’m happy to say that we were able to assure that all leading contenders for passage preserved existing state privacy protections.
As part of its continuing effort to restrict the practice of non-physician health care professionals, the American Medical Association introduced federal legislation intended to make it an unlawful misrepresentation for a non-physician healthcare professional to represent that he or she has “equivalent education, skills or training” to that of a medical doctor. Needless to say the Committee for the Advancement of Professional Practice and the Practice Directorate took strong exception to that. Among other actions, we wrote to Congress to say “The fact is, while not ‘medical doctors,’ doctoral trained psychologists have more training than physicians to prepare them for the services they are licensed by state authority to provide. By virtue of the proposed language which incorrectly presumes that no non-physician healthcare professional could have education, skills or training equivalent to a medical doctor and then prohibits accurate statements to the contrary, this bill would actually prevent consumers from receiving accurate information about psychologists.” To date, the legislation has not moved.
Fighting back Medicare payment cuts has also been at the top of our agenda this past year. First, we were confronted with the automatic 5% cut resulting from the Medicare annual payment formula designed to contain program costs. Just as twice before, we were successful in turning back this cut. And it is definitely worth mentioning that the APA Practice Organization’s appeal to you to help fight this cut by contributing to AAP/PLAN, psychology’s national PAC, resulted in almost $110,000 contributed in just a two-month period.
But the congressional action to fix the automatic rate cut did not include the necessary remedy for the additional 9% cut resulting from the CMS “five year review”. This review led to an increase in reimbursement for all evaluation and management services, and an across the board cut for all other provider services to offset the increase as required by the budget neutrality provision of Medicare law. Not only is the cut, per se, objectionable, but it seems particularly unfair that psychology would be required to bear the cost of increasing reimbursement for E&M services when psychologists are prohibited by CMS from billing for these services. Our work in the coming year will continue to fight against the remaining Medicare reimbursement cuts, and we will continue efforts to gain access for psychology to the E&M codes. You will hear much more about this as you prepare to go to the Hill on Tuesday.
No discussion of Medicare activity of the last year would be complete without mentioning the ongoing effort to implement the new psychological and non-psychological testing CPT codes. Implementation of these codes is necessary for psychologists to realize the full value of the increased reimbursement for testing services we secured last year, the very purpose intended by creation of the new codes. Despite concurrence with us by the AMA with whom we worked on the development of the new codes, CMS has instructed insurance carriers on their use in a manner that prevents use of the codes as they were intended. We are working in collaboration with the APA’s Division of Neuropsychology, the National Academy of Neuropsychology and the Society for Personality Assessment to solve the problem. Once we do, there are also some critical training issues related to using the codes that need to be addressed. The good news is that just two weeks ago, Practice Directorate representatives, AMA staff and CMS staff came to agreement on clarifying language for the codes that should enable them to finally be implemented as we believe they were intended to be.
Mental health parity, it is fair to say, inched along in the 109th Congress. But the story in the early hours of the 110th is much different. Senators Kennedy, Dominici and Enzi have already drafted and introduced a solid and comprehensive parity bill. Importantly, representatives of the business community which has previously opposed parity, have participated in the process and are supporting this bipartisan proposal. Never before have organizations such as Aetna, the American Benefits Council or the National Retail Federation stood shoulder to shoulder with the mental health community on parity. As you know, the bill has already been voted favorably out of the Senate Health, Employment, Labor and Pensions Committee 18 to 3. You have heard me tell you in previous years that we would see a new parity law by that year’s end. One year I told you I was “optimistic,” another year “hopeful” and yet another “cautiously optimistic.” This year with the Democrats in control of the Congressional agenda, support from members of the business community and with the country’s growing awareness that good mental health is required for good health, for the first time, I can tell you I am “confident” that discrimination against people in need of mental health services will finally be achieved through enactment of the Mental Health Parity Act of 2007. You will hear much more about the bill as the conference progresses.
While we are now beginning to transition to more offense on the federal level, a tenacious defense was definitely the key over the last year. So too has a good defense been a necessity at the state level. The Kentucky Psychological Association, for example, successfully defeated two bills attempting to license alcohol and drug counselors with an overly broad scope of practice and potentially limiting those who hold a psychology license from providing addiction treatment. The Kansas Psychological Association has been working to overturn regulations that, in effect, would require licensed psychologists to obtain an additional license in order to offer drug and alcohol treatment. The Michigan Psychological Association blocked an effort by masters level Limited License Psychologists to eliminate their longstanding supervision requirement. The Wyoming Psychological Association worked to push back attempts to eliminate the doctorate as a requirement for school psychologists. The Maryland Psychological Association prevented legislation to allow non-psychologists to do psychological testing. The Indiana Psychological Association has also been fighting back efforts of non-psychologists to do psychological testing. The Florida, Arizona and Georgia Psychological Associations have all been pushing back attempts to limit psychological testing in schools. The New Jersey Psychological Association has been defending against a push to allow non-licensed school psychologists to provide independent services outside of the schools. The Arkansas Psychological Association has, once again, been forced to hold its ground against a challenge to its doctoral level licensing law. But, my favorite example of a successful defense is from the Ohio Psychological Association which killed a bill proposing to allow people to practice healthcare without any license as long as they disclosed they were not licensed to provide healthcare services.
A good defense has also been the order of the day dealing with managed care rate cuts. The Ohio Psychological Association and the Massachusetts Psychological Association have mounted particularly notable efforts to push back the reimbursement cuts. A Monday morning workshop entitled “Rate Cuts and Antitrust Risks: Maintaining the Value of Psychological Services in Managed Care” will look at how to call aggressive plays in this area without getting flagged by the FTC for penalties.
Organized psychology at the state level also mounted a strong offense in many areas to complement its solid defense. No where was this clearer than with efforts to obtain prescriptive authority for psychologists. Despite no new states gaining prescriptive privileges this past year, considerable activity continued. [Slide 19a] The Louisiana Psychological Association and the Louisiana Academy of Medical Psychologists successfully amended the state’s public health statute to ensure that medical psychologists can prescribe in state health facilities. And in New Mexico, new regulations were promulgated to fix a number of the problems from the first set of regulations implemented through that state’s prescriptive authority law.
Building from last year’s progress, the Hawaii Psychological Association’s RxP Legislation passed out of committees in both the House and Senate and is headed to the floor of each chamber. Support from the state’s community health centers, the Hawaii Primary Care Association and Hawaii’s largest insurer, HMSA, continue to make it more than possible that Hawaii will become the next state to obtain prescription privileges for psychologists. For the first time in the prescription privileges movement, two states – Mississippi and Montana -- have seen RxP bills filed, unsolicited, by legislators who then turned to the state psychological associations for help getting the laws passed. The Montana legislation successfully passed out of its first committee but didn’t survive its second reading. In California there are actually two prescriptive authority bills pending, one co-sponsored by the California Psychological Association. The Missouri, Illinois, Georgia and Oregon Psychological Associations have again introduced bills in their respective states, and the Virgin Islands is also expecting to file a bill this session.
The Tennessee Psychological Association has also recently filed a bill, but that hardly tells the story in the state that could be described as literally having been but one vote shy of getting their law enacted in 2005. In 2006, the state medical association introduced a bill proposing a study of over utilization of medication in Tennessee. Tucked at the end of the bill was language, consistent with the AMA’s Scope of Practice Partnership Initiative, calling for a moratorium on any prescriptive authority legislation. TPA was forced to turn its attention away from its RxP bill to defeat this psychiatry-sponsored Trojan horse. But that’s not the end of the story either. Poised to push their bill over the top this year, TPA could only stand by as an FBI sting -- known as operation Tennessee Waltz -- netted several current and former state lawmakers for accepting bribes from lobbyists, including the sponsor of TPA’s bill. Undeterred, TPA is continuing to line up new supporters.
Other notable legislative strides forward occurred at the state and provincial level over the year as well. Thanks to the Utah Psychological Association, Utah joined Washington State as jurisdictions allowing licensure with all supervised experience completed at the predoctoral level. Colorado, Connecticut, Kentucky, Maryland, New Hampshire, Ohio and Wyoming are also hard at work towards sequence of training changes. And, on a different front, the Pennsylvania Psychological Association helped pass a law to increase protection from unsubstantiated licensing board complaints against court-appointed custody evaluators.
In California, the fight to implement existing law and enforce the 1990 California Supreme Court CAPP v. Rank decision in the state hospital continues. You may recall from last year that organized medicine was able to successfully strike the Department of Health Service implementing regulations on procedural grounds. In the meantime, the Union of American Physicians and Dentists -- the lead plaintiff in the litigation -- went back to court in an effort to request attorneys’ fees for its efforts to invalidate the regulations. You will be interested to know that while the Union argued that the litigation served to vindicate an important public right which entitled it to attorneys’ fees, the Superior Court of California disagreed. According to the Court’s opinion, “…it seems clear to the Court that the primary motivation of this lawsuit was not to protect the public but to advance the personal economic interests of member psychiatrists by defeating the regulations that arguably threatened to diminish the responsibility of psychiatrists vis-à-vis clinical psychologists.” Who says justice is blind?
Before moving away from state issues, there is one last achievement to celebrate. While we have a growing number of psychologists serving as legislators (at both the state and federal levels) -- many of whom you will meet during the conference -- we now have our very first psychologist in a governor’s mansion, the Honorable Ted Strickland of Ohio. Congratulations to Ted and his psychologist wife Francis, and to the people of Ohio for finally doing the right thing.
Momentum for change is also building on the national scene in a manner not witnessed since the early 1990s. At least 47 million people, or just under 16% of the population, are uninsured. And, it’s much worse for certain segments of the population. According to a National Coalition on Health Care study, people of Hispanic origin were least likely to have health insurance, with almost 33% uncovered. Significantly, the United States spends $100 billion a year on care for the uninsured, often for serious problems that actually could have been prevented. Total health care spending has reached 16% of the gross domestic product and is expected to reach 20% by 2015. Although nearly $1.9 trillion a year is spent on health care, many people are receiving less care than they need. Some are receiving more care than necessary and many are receiving the wrong kind of care. The Institute of Medicine estimates that 100,000 patients die in hospitals each year due to medical errors -- three times the number who die on the nation’s highways.
The epidemics of obesity and diabetes are also highlighting the need for health system change. According to the CDC, 65% of adults are either overweight or obese, and the numbers are rising. The cost of obesity to the nation is estimated to be $117 billion per year. In turn, obesity is a major contributor to this country’s increasing diabetes problem which, according to the American Diabetes Association, is costing the U.S. economy roughly $132 billion per year.
All of these facts, figures and circumstances paint a dire picture of a health care system in need of change. Perhaps fortuitously, I recently came across a book written by Harvard Business School change management guru John Kotter entitled “Our Iceberg is Melting: Changing and Succeeding Under Any Circumstances.” Taken by the relevance of the title to our present predicament, I immediately started to read it.
In an effort to explicate the challenges of change, Kotter tells a tale of a penguin colony in Antarctica who live as they have, quite comfortably, for many years. Then one day, one curious bird discovers a potentially devastating problem threatening their home. The iceberg on which their home is built is melting. At first, no one listens to him as he tries to warn others. Eventually, the problem is acknowledged, but a solution to the problem is far from certain and every suggestion is subject to seemingly endless debate. In the end, things work out for the penguin colony but not without trial and tribulation. The story Kotter tells is one of resistance to change, heroic action, seemingly intractable obstacles, persistence and clever tactics for dealing with the obstacles to change. Perhaps there is something to be learned from this fable as we pursue change in our healthcare system.
Because the part of our story recognizing a devastating problem threatening our health care system is long behind us, we fast forward Kotter’s story to the penguins’ plight after the community has been persuaded that a serious problem exists and is in need of an urgent solution.
A number of the penguins, frightened about their future, demand that Louis, the head penguin, solve the melting iceberg problem himself. That’s what leaders do, they said. “You are a great leader. You need no help.” And they waited for Louis to provide the solution.
But Louis knew better. “The colony needs a team of birds to guide it through this difficult period,” he said. “I cannot do the job alone.” And, of course, Louis was right. So, they formed a team. At first, everyone on the team couldn’t agree on much. But after spending many, many hours together, they began to actually work together and determined they would be better served by canvassing the colony for suggested solutions.
The first bird they ask suggested they drill a hole from the surface down to the cave to let out the water pressure built up by the melting iceberg. This would not solve the more general problem of the melting, but it might keep their home from exploding during the upcoming winter. But the Professor -- one of the community’s smartest birds -- pointed out that with all 268 birds, the entire colony, pecking away 24 hours a day, they would break through to the cave in 5.2 years.
The next bird suggested they find another perfect iceberg. No melting, no exposed caves, no fissures, just wonderful in every way so that their children and grandchildren would never, ever have to face a crisis like this again. Perhaps they would appoint a perfect iceberg committee. But more reasonable minds prevailed, and the team moved on.
Another idea offered was to move the entire colony toward the center of Antarctica where the ice is thicker and stronger. It didn’t take them long to realize, though, that would take them far from the water, and from their life-sustaining food supply.
One penguin on the leadership council suggested creating a sort of superglue out of killer-whale blubber and using it to glue the iceberg together “real tight.” They were obviously getting desperate, Kotter points out.
Then an older and highly respected member of the colony suggested that they try something new…Walk around, keeping their eyes and minds open. Be curious. The head penguin recognizing the need for a different approach agreed.
Some time later, Fred -- the curious, observant penguin who had discovered their iceberg was melting in the first place – spotted a seagull flying above. This was not typical of the locale, so they wondered if the seagull was lost. But Fred didn’t think the seagull looked afraid, as it would if it were lost, and he wondered if perhaps moving from one piece of land to another was just the way it lived. In fact, when they eventually spoke to the seagull, he said “I’m a scout, I fly ahead of the clan looking for where we might next live.”
The Professor was not totally convinced that what was appropriate for seagulls could possibly be right for penguins. “We’re different," he observed. Alice -- the practical penguin who has a reputation for making things happen -- said “of course we’re different. But the idea is very interesting. I can almost see how we might live. We’d learn to move around. We wouldn’t stay in one place forever. We wouldn’t try to fix melting icebergs. We would just face up to the fact that what sustains us cannot go on forever.”
Unanswered questions disturbed the professor, though. But, that evening he slept remarkably well under the circumstances. He believed the team had succeeded in creating a vision of a new future, and one that seemed plausible. Others on the team were thinking the same way. To make the rest of a long story short, the penguins began enthusiastically communicating to the rest of the colony the new vision of a nomadic life and of a very different future. Eventually others began to embrace the vision as well. They organized a group of scout penguins to look for possible new homes, and they engaged the rest of the colony to help as well. The scouts were considered heroes by their fellow penguins. They found another iceberg that could sustain them, and the colony moved. The next season, despite some rumblings to stick with their current home, the scouts found a still better iceberg, larger and with richer fishing grounds. The next season, they moved again, each move less traumatic than the last. Other changes in the colony occurred. A tough selection process was created for the scouts. They were also given more fish. And their status within the colony went up even further. The penguin school system added “scouting” as a new required subject in the curriculum. Today, the colony moves around like nomads. Most have accepted it. Some love it. Some never will.
The point of the story is that efforts to simply fix the broken health care system must give way to efforts to truly create a new one. In its simplest form, Kotter would say we must set the stage by creating a sense of urgency and putting together the guiding team. We must develop the vision for change and the strategy to achieve it. We must communicate to and empower others. And, importantly, we must create a new culture to replace old traditions and old ways of behaving.
Creating and communicating the vision for a new health system will surely not be so easy as solving Kotter’s melting iceberg problem. But that must not keep us from trying. Recently, an unlikely coalition of business, labor and consumer groups have begun to call for “a new American health care system.” Proposals for change have also come from the White House, Capital Hill, the presidential campaign trail, and governors around the nation. As noted by a recent Wall Street Journal article, “Parties that disagree on other issues have found common ground on health care.” Perhaps this is the beginning of a guiding team for a new approach to solving the problem.
But, what about the vision and strategy? While it is too soon to say exactly how, for example, consumer-driven healthcare can come together with government engagement for universal coverage, one thing continues to be clear -- the health care system’s fixation with treating disease must give way to a greater priority to prevent disease and promote good health. As we have described in our last two State Leadership Conferences, lifestyle and behavior are key to promoting health and preventing disease. But our next speaker will likely tell you, so long as we have a system more willing to pay for treatments than for technologies, information, and discoveries to keep people healthy, we are doomed to simply trying to fix the iceberg.
So what can we penguins here in psychology do to help? For the last two years, I have reminded us of our profession’s unique and central role at the intersection of psychological and physical health. A future vision of a health system that relies on connections between behavior and health actually reaches squarely back into psychology’s past. What policy makers and the public are now beginning to appreciate, psychology has known for years, if not decades -- the research, the knowledge base, and technologies to change behavior in ways that promote good health do exist. And, much of the research, the knowledge base and technologies are psychology’s work. No matter the mechanism of change occurring in health care, we must continue our efforts to assure that our work is fully appreciated by policy-makers, employers and the public. Both, our Mind-Body Health Public Education Campaign and our Psychologically Healthy Workplace program are designed to do just that.
The public and media interest in our mind-body health messaging has been significant, particularly the stress survey findings that highlight the many unhealthy behaviors people are using in an effort to manage their reported high levels of stress. Smoking, drinking, fast food and comfort eating were more frequent then healthy means of stress management. While not surprising to many of us, finding that those most concerned about stress were also more likely to report being overweight, being obese, having high cholesterol or hypertension -- not to mention being anxious or depressed -- did seem to be big news to the general public. Stories based on our stress surveys were run by literally thousands of newspapers, magazines, radio and TV stations. USA Today, the Washington Post, the Boston Globe, the Boston Herald, the Miami Herald, Glamour Magazine, Good Morning America, HispanicBusiness.com, MSNBC.com and the BBC, to name just a few, zeroed in on the link between stress, unhealthy stress management behaviors and the ill health of the nation.
When you also consider that the most frequently cited source of stress in our surveys was workplace stress, helping employers create psychologically healthy workplaces is another important contribution we can make to a new health system in this country. According to the American Institute of Stress, workplace stress costs the country $300 billion a year. Interestingly, a comparison of the employee stress levels of this year’s National Psychologically Healthy Workplace Award winners against the national average is striking. Nineteen percent of our PHWA winners’ employees report high work stress compared to 33% one average nationwide. And, the turnover rate of this year’s winners is less than one-third the national average. For these and other reasons, we are happy to say that four more associations have joined the Psychologically Healthy Workplace Awards program – Nebraska, North Carolina, Ontario and Rhode Island -- bringing the total to 48 states, provinces and territories.
Simultaneous to this transformation in health that is just beginning is a transformation in technology that is well underway. The two will eventually intersect as an efficient health system built around an informed consumer will require accessible, easily shared, secure heath information, as well as transparency of information when it comes to cost and quality. Towards this end, our profession will need to continue to work diligently to assure that privacy is protected, and that evidence-based practice, outcomes measures and pay-for-performance programs -- the buzzwords of today’s efforts to refocus on quality -- are not high-jacked in the service of economic interests and profit motive. To hear more about that, don’t miss the featured presentation Sunday afternoon entitled “Arming Yourself with Knowledge on Evidence Based Practice.”
The health system aside, however, I also believe there will be an important role for psychologists within the massive information technology transformation underway. Tapscott and Williams, in their recently published book, Wikinomics -- How Mass Collaboration Changes Everything, talk of deep changes in technology, demographics, business, the economy and the world which have created a new age where people participate like never before. This new participation, they say, has reached a point where new forms of mass collaboration are having profound effects on our culture, as well as our economy. Peer production, or “peering” as they call it, describes the process when masses of people and firms collaborate openly online to drive innovation and growth in their industries. Wikipedia, MySpace, InnoCentive and YouTube are just a few examples.
Rather than just read a book, Tapscott says, you can now write one. Just log onto Wikipedia, a collaboratively created encyclopedia, which in the past year has been cited four times as often as the Encyclopedia Britannica in judicial opinions. Register on InnoCentive and you can join with 90,000 other would-be scientists to help solve corporate research and development problems for a cash reward. Subscribe to SecondLife.com and you can create an alternative identify for yourself and interact with 4 million “residents” of the virtual community who spend real dollars to buy virtual property, goods and services. Rather than watch TV news or entertainment, you can actually create it on sites like YouTube and MySpace.
This is Web 2.0, the technology which Time Magazine called a “revolution” of community and collaboration on a scale never seen before, and which led the magazine to select as its person of the year, ‘the people now in control of the Information Age” -- You.
But TV news anchor Brian Williams has a different take on the effects of this growing online community. “The larger dynamic at work,” he says, “is the celebration of self. The implied message is that if it has to do with you or your life, it’s important enough to tell someone. Publish it, record it, but for goodness sake, share it. Or not. The assumption is that an audience of strangers will be somehow interested, or at the very worst not offended… It is now possible - even common - to go about your day in America and consume only what you wish to see and hear. The problem is that there’s a lot of information out there that citizens in an informed democracy need to know in our complicated world with U.S. troops on the ground along two major fronts. Millions of Americans have come to regard the act of reading a daily newspaper -- on paper -- as something akin to being dragged by their parents to Colonial Williamsburg. It’s a tactile visit to another time…flat, one-dimensional, unexciting, emitting a slight whiff of decay. It doesn’t refresh. It offers no choice. Hell, it doesn’t even move. Worse yet, nowhere does it greet us by name. It’s for everyone. Does it endanger what passes for national conversation if we’re all talking at once? What if “talking” means typing on a laptop, but the audience is too distracted to pay attention? The whole notion of “media” is now much more democratic, but what will be the effect on democracy? The danger just might be that we miss the next great book or the next great idea or that we fail to meet the next great challenge…because we are too busy celebrating ourselves and listening to the same tune we already know by heart.”
Irrespective of your view of the benefits and liabilities of technology, its role in transforming the way we live is inescapable. Scott McLeod, Director of the Center for the Advanced Study of Technology Leadership in Education at the University of Minnesota perhaps best brings this point home with a few minute slide show he has put together and circulated on the Internet. Let’s watch…
Beyond psychologists’ role as mental health professional, beyond our role as health professionals, we are now challenged to step up our role as experts in behavior to help guide this technology-driven shift. While some, like Tapscott, applaud the move into virtual reality and others, like Williams, are more skeptical, the outcome of this journey is far from certain. Whether it will be for the better or collective worse will depend, of course, on how this transformation is managed.
Just a decade ago Robert Putnam wrote of the disintegration of community in Bowling Alone: America’s Declining Social Capital. Perhaps technological advances of the last ten years are bringing about a return to and community. Yet, there is a disconnect between the traditional notion of community which required some sacrifice of the self in the service of unity and community and the virtual community of today which seems built, as Brian Williams points out, on celebration of the self. Without a doubt, the web-enabled community of tomorrow will not be the same as the community of yesterday or today. Nor should it be. Who knows, it is entirely possible that MySpace is actually in the process of becoming “OurSpace” and “YouTube” is scheduled to morph into “OurTube.” And the Time person of the year in 2015 may be “us.”
The point is, important shifts are occurring -- in health care, in technology and in our culture. It is incumbent upon us as psychologists to use our research, our knowledge base and our technologies in the service of those shifts. Our expertise in behavior – both for solving problems and enhancing performance – makes our profession well suited to help manage these changes around us.
But we must also effectively manage change within our profession as well. We must continue to diversify our way of practicing to take advantage of the varied roles psychologists are capable of filling. While we may create a sort of superglue out of killer whale blubber to glue together “real tight” the broken reimbursement system, we must simultaneously transition to an income model of practice. Undertaking activities that do not depend on shrinking third-party reimbursement is crucial if we are to thrive economically. For a look at some of the possibilities, don’t miss the Monday workshop entitled “Practitioners on the Road Less Traveled.” We must continue to be curious and creative, walking around keeping our eyes and minds open, looking for good solutions to our profession’s problems, and looking for solutions to society’s most pressing problems.
Last year, I challenged us to find more ways to participate with the many communities that surround us. Not just other health professions, but civic groups, cultural groups, religious groups and service organizations. All are important places for psychologists to be if we are going to make a difference. I would continue that challenge again this year. In fact, I would say it is more important than ever. When you attend the Monday plenary entitled “Expanding Psychologists’ Roles, Influence and Value in the Public Eye,” you will hear from some in the first-responder community with whom we have worked. You will hear them describe a need for psychologists to provide important services in times of disaster. But you will also hear them say that active participation with their community before disaster hits is a prerequisite. They won’t accept help from strangers. They will accept help from those with whom they have prior relationships.
To truly expand our roles, maximize our influence and increase our value, we must continue to build our relationships with communities beyond our walls. This is especially key at a time when the health care system is changing, when the world is changing, and when we are changing. Shift happens. Now we know. Now we must act.
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