Creative Minds - Fascinating Journeys

When many of us think of the contributions of Minnesota psychology, the MMPI immediately comes to mind, as it well should — dating back to 1943.  The personal journey of MMPI expert, and now Professor Emeritus, James Butcher exploring Watercolors as a late-life adventure, and the extraordinarily impressive APA governance service of his University of Minnesota colleagues Bruce Overmier and Jo-Ida Hansen, seem equally significant however.  As editor of Psychological Services, I had the pleasure of working closely with Shelia Brandt on behalf of the profession’s public service members.  Having worked on Capitol Hill for nearly four decades, I was very pleased to learn of her growing interest in becoming involved in the public policy process.  This year she is serving as a Humphrey School of Public Affairs Fellow.  Those fortunate to attend the annual Practice Directorate State Leadership Conferences (SLC), which in my judgment are one of the highlights of the APA year, have recently been exposed to the vision and dedication of another explorer, Art Evans, Commissioner of the Department of Behavioral Health and Intellectual Disability Services for the City of Philadelphia.

Arthur C. Evans, Jr. is a psychologist and frontline policymaker who oversees a one billion dollar behavioral healthcare system in Philadelphia.  Growing up in Florida in the 1970s, the unlikely journey that brought the son of a school teacher and an Air Force electronics technician to his current position was somewhat circuitous.  After graduating as a music major at a local community college, his psychology teacher asked him what he planned to do next.  He admitted he didn’t know, but, while he enjoyed the field a great deal, he did not want to major in psychology, because he thought it would take him too long to complete school through to a doctorate.  That brief conversation altered the course of his life as his teacher encouraged him to pursue his real interest and identified a couple of colleges that he could attend, including Florida Atlantic University (FAU) where he would matriculate with a bachelors and master’s degree in experimental psychology.  At FAU he received rigorous training in research, including a year of full time work experience through a co-op at the United States Army Aeromedical Research Laboratory.  He credits this strong scientific foundation to a core belief; that the answers to many of the complex problems that society faces may lie in psychological research.  But, he has observed, the dots between the researchers and those trying to resolve the problems often remain unconnected.

Earning his doctorate in clinical/counseling psychology at the University of Maryland at College Park, this turned out to be an ideal training program for the career for which he was ultimately preparing.  With his upbringing in 1970s Florida, he was acutely aware of the challenges facing the African-American community and felt compelled to put himself in a position where he could help the community.  He reasoned that because there were very few African-American psychologists – he had only met one at the time – it would be important for him to have the broadest possible training in order to be able to serve in as many roles as possible.  While some of his colleagues endeavored to specialize, he sought a wide skillset that would allow him to work with people experiencing a range of conditions.  But he was fascinated by the training that related to community psychology.  Both the underlying philosophy and values, as well as the techniques, such as ecological assessments, were very much aligned with his view that psychology should be both intra-psychically focused, as well as focused on the social factors that affected psychological health.  During his second year at Maryland, he had the opportunity to do an internship at what would later be called the APA Office of Legislative Affairs.  Learning the critical role that policy played in addressing mental health issues through this APA experience, it planted the desire to do work at the policy level that would come to fruition many years later.

Yale University School of Medicine, where Art completed his pre-doctoral internship, was one of the only programs in the nation where one could receive both clinical and community psychology training.  It was an ideal launch pad for the career that he has pursued.  His internship allowed him to consolidate his training in experimental, clinical and community psychology and, given the complexity of the work involved, his diverse training was very useful.  After finishing up at Yale, he decided to remain in New Haven and take a position as the clinical director of a new medical detoxification center that was being developed.  He also joined the clinical faculty at Yale and started a private practice and consulting business with several partners.  This combination of clinical, administrative, research, and teaching activities was a great fit and set the stage for the rest of his career to date.  Learning to manage multiple and diverse activities simultaneously was both rewarding and necessary for the types of positions that he has undertaken.  All have required a broad range of skills.  For example, developing a new medical detoxification center requires administrative skills, clinical knowledge, political acumen, the ability to conceptualize how a program fits into an existing system of care, and the ability to use research to drive program design, to name a few.  Drawing from the various pools of his training and experiences has become a way of life when it comes to his work.

After several years in New Haven, Art was invited to delve into policy work at the Connecticut Department of Mental Health and Addiction Services at the State Capital in Hartford, initially as the agency’s first Director of Managed Care and then later as the Deputy Commissioner for the agency – a political appointment.  In both of these positions he was tasked with creating programming and developing new approaches to service delivery.  Shortly after being appointed Deputy, Commissioner Thomas Kirk (also a psychologist) made the policy decision to adopt “recovery” as the overarching framework for organizing the Connecticut Behavioral Healthcare System, becoming the first behavioral health system in the nation to do so.  Working with several psychologists and others in the field, including a large number of people in recovery from mental health and addiction problems, they undertook the task of figuring out conceptually and practically what this would mean and began employing the strategies necessary to make this major paradigm shift.  This work continues today both in Connecticut and Philadelphia, where Art currently serves as Commissioner of the Philadelphia Behavioral Health System as he has since 2004.

In Philadelphia, Art has been singularly focused on the transformation of the city’s large behavioral health system.  This involves hundreds of millions of dollars, hundreds of employees, tens of thousands of service recipients and ensuring a safety net for a city of 1.5 million people.  The transformation of the behavioral healthcare system is focused on recovery and resilience outcomes and has required working at multiple levels and domains simultaneously.  For example, the department has invested heavily in empirically supported treatments and has formed partnerships with clinical researchers such as Aaron Beck, M.D. and Edna Foa, Ph.D. to do large-scale implementations of evidence based practices.  Simultaneously, Art and his colleagues have used financial incentives to improve provider performance, developing performance metrics for 90% of their service system.  In addition to improving clinical service delivery, much of their focus has been on non-clinical strategies that they believe are essential to helping people achieve the best possible outcomes.  For example, Philadelphia has one of the most robust peer programs in the nation, training and deploying hundreds of people in recovery from mental health and addiction problems throughout their system from acute inpatient settings to assertive community treatment teams.  Community work also includes working with members of diverse faith backgrounds who can support recovering people within their congregations and working with indigenous community leaders from immigrant groups to develop alternative pathways into treatment, as well as culturally responsive support services.

Art Evans believes that the next frontier for behavioral health is the adoption of a public health framework and strategies to address the psychological health of people.  This has many implications for psychology including the development and incorporation of population-based interventions, focusing on population health, addressing psychological wellness – as opposed to an often singular focus on treating pathology – and greater emphasis on prevention and early intervention.  At SLCs Art has called on Psychology to play a major leadership role in moving the field in this direction.  It will require though, connecting the dots from many areas of psychology.  If psychology does begin connecting the dots to address the complex challenges facing communities and the nation’s healthcare system, the field will thrive over the next several decades.

 Vision And Personal Involvement Is Not Limited To Any Profession:  One of the hallmarks of the Uniformed Services University of the Health Sciences (USUHS) (DoD), where I currently enjoy teaching a health policy class, is an interdisciplinary collaboration at the educational, clinical, and research level.  Lucinda Maine, Executive Vice President of the American Association of Colleges of Pharmacy (AACP), shared her profession’s appreciation for the long term importance of public policy involvement:  “Institute of Medicine (IOM) member J. Lyle Bootman, Dean of the University of Arizona College of Pharmacy and 2012-2013 President of the AACP, challenged his members to ‘Get to tables of influence’ to insure that pharmacists’ roles in improving health and health care could be maximized.  He did not overlook the power of the IOM tables in implementing his own recommendation.  With resources from AACP and other organizations, a fellowship was endowed in the IOM Anniversary Fellowship Program.  Every other year in perpetuity a pharmacist from academia, practice or both will be selected to serve as the Pharmacy Fellow at IOM.  Over two years they attend IOM meetings, work to support study committees, forums and other IOM groups.  Dr. Sam Johnson, affiliated with the University of Colorado in Denver and a leader in pharmacogenomics at Kaiser’s Rocky Mountain Health System, assumed the position of inaugural fellow in October, 2012 and will complete his experience in October, 2014.  He describes his experience as nothing short of ‘life changing.’  It is clear that he has made an important imprint on the work of the IOM as well.”

The importance of “escaping from one’s professional silo” and appreciating the past was underscored by USUHS colleague Mike Feuerstein: “Especially in psychology, sorry to say.  Someone’s innovation is another’s past effort.  Maybe that is how progress occurs in life and why it takes so long.  Can be frustrating but you don’t get to see it until you are ‘older.’”  Aloha.

Pat DeLeon, Ph.D., JD, served as APA President in 2000.  He retired recently as chief of staff after 38-plus years working for US Senator Daniel K. Inouye.  He is a member of the Institute of Medicine.  

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