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Workforce Issue Addressed

Because I am very active in the Academy of Child and Adolescent Psychiatry (AACAP), colleagues often ask me why I maintain my APA membership, especially since my APA dues are nearly twice my AACAP dues. My response is that AACAP, with just 7,000 members, cannot "go it alone" on legislative issues, where the size of one's base can be critical. Child and adolescent psychiatry needs APA to carry our banner on issues of critical importance to the future of our subspecialty.

When I received my April 1 issue of Psychiatric News, I turned with interest to the article titled "APA Advocacy Agenda Focuses on Access Issues." For child and adolescent psychiatry, the primary access issue is the shortage of child mental health practitioners, particularly the shortage of child and adolescent psychiatrists. I knew APA supported the Child Health Care Crisis Relief Act, a bill sponsored by Rep. Patrick Kennedy. Susan Ishiyama, M.D., an APA-sponsored legislative fellow, worked on this legislation. The bill has three elements: (1) loan repayments, scholarships, and grants to support training in child mental health specialties; (2) reinstatement of child and adolescent psychiatry training in the Medicare Graduate Medical Education Program, and (3) reporting by the Health Resources and Services Administration on the distribution and need for child mental health services professionals.

I read the article to see how the issue would be presented to its readers. I did not expect to find the child mental health workforce issue ranked ahead of parity or the Medicare copayment issue or even the new Medicare Part D drug benefit, but I was shocked that the chief access issue for child and adolescent psychiatry did not make it into the article at all!

APA President Michelle Riba, M.D., responds:

Due to space limitations, the article about advocacy in the April 1, 2005, Psychiatric News was necessarily just a snapshot of APA activities. But because this issue is so important, a full-length article on the Child Health Care Crisis Relief Act was being planned at the same time for the April 15 edition and was published under the headline "Bill Seeks to Rectify Shortage of Child MH Clinicians."

With respect to the workforce issue, APA has in fact been directly involved with Rep. Kennedy's "workforce" bill since its original development. The legislation was prepared and fine-tuned by an APA-sponsored fellow who spent a six-month fellowship in Rep. Kennedy's office. Staff of APA's Department of Government Relations (DGR) provided considerable input on the draft legislation as, of course, did AACAP members and staff.

APA also participated in the Kennedy press conference when the bill was initially rolled out. Since that time, our DGR staff has participated in numerous Hill meetings with congressional staff along with colleagues from AACAP, American Academy of Pediatrics, NMHA, NAMI, and others to raise awareness of the workforce issue and secure co-sponsors for the legislation. At press time, the bill had 33 cosponsors in the House (HR 1106) and nine cosponsors in the Senate (S 537).

In addition, APA works closely with AACAP on a wide range of policy issues including filing joint comments on a proposed DEA rule adversely impacting access to psychotropic medications for children and adolescents, sending a joint letter to Capitol Hill opposing the mental health screening bill sponsored by Rep. Ron Paul (R-Texas), preparing joint testimony on FDA policy on SSRIs and their use in the pediatric population, and encouraging members of Congress to support the enactment of the Child Health Care Crisis Relief Act.

I would like to thank Dr. Ritvo and AACAP for supporting issues of importance to psychiatry and to our patients, and we look forward to continuing our strong collaboration with AACAP on these issues.

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