APA Council Reports

In 2018, CAGR established a work group to craft and propose a revised charge that clarifies, focuses, and better reflects the operations and objectives of CAGR. The work group presented draft language in the fall to the APA Joint Reference Committee (JRC) for a vote of approval. After an extensive discussion and the addition of further clarifications, the JRC unanimously voted to approve the new CAGR charge and recommend its adoption. In December 2018, the APA Board of Trustees adopted CAGR’s new charge. Throughout 2019, CAGR continues to implement its charge in a variety of ways, summarized below.

On March 11th and 12th, 100 APA members participated in the 2019 Federal Advocacy Conference in Washington, DC. Through this conference, APA members met with representatives from over 130 congressional offices to advocate for greater mental health parity, improved care coordination for individuals with substance use disorder, funding for mental health crisis services, and policies addressing the mental health workforce shortage. CAGR members played a pivotal role in educating other APA members about APA’s legislative priorities, as well as providing skills training on conducting meetings with legislative officials and staff.

With another State Advocacy Conference planned for next year, CAGR members began a discussion at the May Annual Meeting to determine how it can leverage its experience to augment members’ experience at this conference, and CAGR expects to continue that discussion in the coming year.

Building on APA and CAGR’s success at educating APA members and members of Congress about the need for further MH/SUD parity legislation, APA worked to facilitate the introduction of federal parity legislation (H.R. 3165 / S. 1737) that requires insurers to “show their work” in certifying their compliance with the federal parity law. The bill requires insurers to conduct and produce comparative analyses to show that they are, in fact, complying with federal parity law.

APA also successfully included its parity legislation in the Senate Health Education Labor and Pensions (HELP) Committee’s package of legislation intended to lower the cost of health care (S. 1895, the Lower Health Care Costs Act). On June 26th, the Committee approved the bill on an overwhelmingly bipartisan basis by a vote of 20–3.

APA continues to advocate for adequate funding of APA’s priority MH/SUD programs, including but not limited to programs housed within the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institutes of Health (NIH), and the Health Resources and Services Administration (HRSA). In April, APA sent its annual letters to the leadership of House committees and subcommittees with jurisdiction over funding for these programs. Among several other requests, APA requested increased funding for the Community Mental Health Services Block Grant and the Minority Fellowship Program, as well as an initial investment in the Loan Repayment Program for Substance Use Disorder Treatment Workforce program enacted under last year’s opioid bill.

In light of recent mass shootings, APA also continues to advocate for public funding of research on gun violence. On February 21st, APA joined 165 other national, state, and local medical, public health, and research organizations in a letter to key members of the House and Senate, calling for $50 million in funding for the CDC to conduct public health research into firearm morbidity and mortality prevention.

APA continues to call attention to the trauma inflicted upon children under the current federal immigration policy, having released numerous statements from APA leadership on this topic. On February 27th, APA Past President Dr. Altha Stewart testified before the U.S. House of Representatives Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. As the only physician witness, Dr. Stewart highlighted how traumatic these experiences can be for children and how exposure to “toxic stress” often leads to an increased risk of mental illness later in life. She also reiterated APA’s opposition to family separation at the border and the need for staff at detention centers to be trained in trauma-informed care.

APA continues to support the Affordable Care Act as a means of expanding access to affordable coverage for evidence-based MH/SUD services. On December 14th, 2018, a federal district judge issued an opinion holding the Affordable Care Act unconstitutional following Congress’ elimination of the penalty for failure to obtain health insurance. APA promptly released a statement calling for a “vigorous appeal” of the district court’s opinion “to protect access to health care for millions of Americans.”

On April 3rd, APA sent a letter expressing support for several ACA market stabilization bills advanced to the House floor by the House Energy and Commerce Committee. Among the proposals supported by APA include H.R. 1010, which invalidates the Trump Administration’s rule expanding the availability of short-term limited duration plans that are not required to comply with the ACA’s core consumer protections; H.R. 986, which would direct the Trump Administration to rescind its guidance to states that loosen the standards for the ACA’s Section 1332 “state innovation waivers”; and H.R. 1425, which creates a new reinsurance program to help offset the cost of insuring high-risk individuals and lower premium prices.

On April 3rd, Reps. Earl Blumenauer (D-OR) and Markwayne Mullin (R-OK), as well as Senators Joe Manchin (D-WV) and Shelley Moore Capito (R-WV), introduced legislation (H.R. 2062 / S. 1012) intended to modernize patient privacy protections by aligning 42 CFR Part 2 with HIPAA’s standards for treatment, payment, and health care operations. Consistent with the bill the House passed last year, the reintroduced bill also amplifies consumer protections by incorporating antidiscrimination language and enhancing penalties for any breach of a patient’s privacy concerning substance use disorder records. APA continues to work with its coalition partners to educate and engage members of Congress regarding the issue and encourage passage of the legislation. APA sent an action alert urging members to call their legislator and ask him/her to support the bill.

Congress has spent a significant amount of time this year assessing hundreds of proposals designed to address the rising prices of prescription drugs. In 2019, at least 15 committee hearings and markups have been held across seven committees to examine possible strategies to lower drug costs. Some of these hearings are more open-ended discussions around perceived problems or solutions, while other hearings are meant to discuss a specific piece or package of legislation.

Given the broad scope of the legislation introduced this year, APA staff formed a workgroup of members from both the Council on Advocacy and Government Relations (CAGR) and the Council on Healthcare Systems and Financing (CHSF), with Dr. Brian Hart from CAGR and Dr. Jennie Byrne from CHSF agreeing to co-chair this group. The goal of this workgroup is to review APA’s current policies and principles on drug pricing to see if any changes need to be made, such as new position statements or further clarification of existing positions. The workgroup will also provide feedback on how to prioritize our legislative and regulatory efforts to ensure that patients are able to access their medication.

APA continues to partner with district branches (DBs) and state psychiatry associations across the country in responding to priority DB legislation, utilizing the experience of CAGR members where appropriate. In 2019, state-led initiatives include parity enforcement, scope of practice concerns, maintenance of certification (MOC), involuntary commitment, expanding treatment for substance abuse disorders, and adoption of integrated care models, such as collaborative care.

As part of APA’s state advocacy efforts, the Committee for Advocacy and Litigation Funding (CALF), currently chaired by Dr. Bhasker Dave, reviews DB/SA grant requests for specific public affairs challenges on the state level. Due to limited budgets in many of APA’s DBs/SAs, CALF grants are heavily relied upon by states in confronting new legislative policy challenges. Once CALF approves an initial request from a DB/SA, the request is sent to voting members of CAGR to approve, and the Board of Trustees (BOT) makes the final determination to award a grant. So far this year, CALF, CAGR, and the BOT have approved CALF grants to Illinois, Kentucky, Louisiana, Rhode Island, and Texas.

The APA Political Action Committee (APAPAC) APAPAC is the bipartisan political voice of the APA that enables the Association to invigorate its patient and professional advocacy activities by supporting candidates for federal office. APAPAC (R. Scott Benson, M.D., D.L.F.A.P.A., Chairperson) is governed by a board of directors comprised of 14 APA members. The PAC works to ensure the election of federal candidates/incumbents who share mutual principles and goals with APA and who champion psychiatry’s position throughout the legislative process. Another role of the PAC is to educate Members of Congress as to why they should support positions vital to our patients and profession. The PAC raised over $575,000 from APA members during the 2018 election cycle. Increasing our total cycle fundraising is the APAPAC’s top priority. Although APAPAC is among the smaller physician PACs, we are poised for growth. The APAPAC Congressional Advocacy Network (CAN) is another tool we use to bring an even greater voice to psychiatry’s advocacy efforts. There are almost 200 members of the APA participating in the CAN program, which is designed to help develop, train, and energize a national network of psychiatrists who will commit to communicating and build personal relationships with members of Congress and speak on behalf of the APA on issues facing mental health.

The Council opposed the inclusion of Medicaid and Children’s Health Insurance Plan (CHIP) and called on DHS to rescind this rule and not consider the use of public benefits programs, like Medicaid, the Supplemental Nutrition Assistance Plan (SNAP), and income-level tests in public charge determinations. The Council reinforced the APA’s position that immigrants, refugees and displaced persons be treated with dignity and respect during all stages of the migration process.

In response to DHS’ proposed changes to the regulations established by the Flores Settlement Agreement (FSA) (Apprehension, Processing, Care and Custody of Alien Minors and Unaccompanied Children Concerns), the Council highlighted the negative mental health impacts of this policy change on children and their families and recommended that the maximum period of detention for children and their parents to not exceed the current limit of 20 days. The APA recommended that DHS hold detainment centers to the maximum safety and compliance requirements and make no exemptions to these standards. The Council further recommended that in order to improve each Family Residential Center (FRC) ability to identify and treat patients with unidentified or unmet health and mental health needs, staff should be educated on the delivery of trauma-informed and culturally competent care to this displaced population.

Position statements on “Elder Abuse, Neglect, and Exploitation” and on “Sexually Transmitted Infections, including HIV, among Older Adults” were published in early 2019.

In May, the Assembly approved position statements on “The Role of Psychiatrists in Nursing Facilities” and “Disaster Response and Older Adult Mental Health Care.” Both statements are currently under review at other levels of APA leadership.

Given the climate regarding the prescribing of all psychotropic medications to older adults, the Council felt that it would be valuable to develop a position statement addressing the broader issue of the use psychotropic drugs in the elderly in all settings. The Council has partnered with the American Association of Geriatric Psychiatrists in this effort.

The Chair of the Council on Consultation-Liaison Psychiatry contacted the Chairs of the Council on Geriatric Psychiatry and the Council on Addiction Psychiatry to ascertain their interest in looking at ways to enhance recruitment into subspecialty fellowships. A task force was formed consisting of volunteers of these three Councils. The goal of the task force is to make recommendations for APA councils and subspecialty organizations to consider addressing subspecialty workforce challenges and general psychiatry training/education opportunities in addiction psychiatry, geriatric psychiatry, and consultation-liaison psychiatry.

The Council on Geriatric Psychiatry discussed the issue and some potential solutions. The discussion revolved around two major themes:

The Council was asked to offer comments on the draft practice guideline from the American Psychological Association entitled “Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults.” Council members reviewed the document and provided the following feedback:

In 2004, the Committee on Ethnic Minority Elderly of the Council on Aging developed a curriculum about how to provide culturally competent care to older adults. Recently, the Council on Geriatric Psychiatry undertook a revision of the curriculum. This effort was led by Dr. Maria Llorente and involved many current and past Council members, APA/APAF Fellows, and other trainees. The result was the book Culture, Heritage and Diversity in Older Adult Mental Health Care, which was published in late 2018 by American Psychiatric Association Publishing.

As in past years, the Council recommended honorees for the Jack Weinberg Award in Geriatric Psychiatry and the Hartford-Jeste Award for Future Leaders in Geriatric Psychiatry. The Jack Weinberg Award recognizes psychiatrists who have made noteworthy contributions to geriatric psychiatry as researchers, mentors, leaders and clinicians over the course of their careers. The 2019 award recipient was Dr. Iqbal “Ike” Ahmed, M.D. The Hartford-Jeste Award recognizes an early-career geriatric psychiatrist who has made significant contributions to the field of geriatric psychiatry through excellence in research, teaching, clinical practice, and community service, and has demonstrated the potential to develop into a future leader in the field. The 2018 awardee was Dr. Jennifer Gatchel. The awards were presented at the 2019 Annual Meeting in San Francisco.

Henry Chung, M.D., Chairperson: The Committee on Integrated Care has finalized its addendum to the Resource Document on “Risk Management and Liability Issues in Integrated Care Models,” which focuses on liability issues related to cross-state consultation for integrated care. The Council and the Board of Trustees voted to approve the addendum, and it has since been posted on APA’s website. The Committee is also developing a brief on the advantages of collaborative care for risk bearing contracts and accountable care organizations.

Gregory Harris, M.D., M.P.H., Chairperson: Members of the Committee on RBRVS, Codes and Reimbursements have been focused on revising and updating the educational materials related to CPT coding and documentation and continue to serve as a resource on specific CPT coding questions. The group has helped to inform our advocacy efforts following CMS’ proposal to make drastic changes to the E/M coding structure. This work has now moved into the CPT and RUC arena where APA has been actively engaged, along with more than 50 other organizations. This has included participation in meetings and telephone calls with members of the Administration. In the immediate future, the Committee will be developing some resources related to coding and billing for the administration of esketamine nasal spray, which was approved, with limitations, by the FDA.

Laurence Miller, M.D., Chairperson: The recently adopted Core Principles for Alternative Payment Models was developed by the Committee on Reimbursement for Psychiatric Care. Members have been identifying and gathering additional information on clinical models that could be paid for under an alternative payment model, which includes possible payment structures for substance use disorder or opioid use disorder treatment, such as MAT, coordinated specialty care for first-episode psychosis, and other payment models to address care transitions. Additionally, members of the Committee have assisted in the evaluation of a proposed episode-based cost measure for patients with psychosis. The Committee will continue to work with the Council on Quality Care to monitor that measurement development process.

Jay Shore, M.D., M.P.H., Chairperson: The Committee on Telepsychiatry has expanded its Telepsychiatry Toolkit. Working in cooperation with the American Academy of Adolescent and Child Psychiatry (AACAP), the Committee added 18 new videos and associated literature references to the toolkit, featuring content highlighting the unique practical, legal, and regulatory implications of using telepsychiatry with patients. The Committee has also begun adding video content to APA’s regularly updated Telepsychiatry Blog. The first “vlog” entry introduces viewers to the work of the Committee and provides an overview of the use of telepsychiatry in practice. Subsequent entries provide practical examples of how to use the technology in session, offer tips on how to remain compliant with local, state, and federal regulations, and give pointers on using telepsychiatry with special populations. Members of the Committee have also rolled out their new Telepsychiatry Newsletter.

The Council’s Work Group on Temporary Protected Status (TPS) developed a Position Statement on Mental Health of Foreign Nationals on TPS, which is under consideration by the APA Assembly. The background of the position statement notes that in 1990, the United States established the TPS program allowing foreign nationals unable to safely return to their home country due to catastrophic circumstances such as war, famine, natural disaster or epidemic, to remain in the United States. Countries currently part of the TPS program include El Salvador, Haiti, Honduras, Nepal, Nicaragua, Somalia, Sudan, South Sudan, Syria, and Yemen. In 2018, the TPS program was rescinded, affecting hundreds of thousands of foreign nationals in the United States. confronted with the possibility of returning to unsafe countries. Individuals and families under TPS face emotional, physical and psychosocial stress due to the uncertainty of their status, potential family separation, and are at risk of developing or exacerbating mental health problems. Unfortunately, many health providers, including psychiatrists, are unaware of this immigration status and its impact on individuals and families. The position statement encourages increased awareness of the TPS program as an immigration issue, aims to educate healthcare providers about the particular mental health concerns of the individuals in the U.S. under TPS, advocates for active screening for mental health symptoms and access to health care, including mental health care, and treatment for individuals and families under TPS, and to support funding of research on the mental health impact of TPS on individuals and families.

The Council reviewed a drafted position statement from the Chairs of Departments of Psychiatry that departments of psychiatry with training programs must be led by a board-certified psychiatrist.

The Council was asked to weigh in on expanding addiction requirements in residency training and continues to look at this issue.

The American Board of Medical Specialties organized Vision Commission posted its draft report from their two-year study of the future of Maintenance of Certification (MOC). Members of the Council reviewed the report and contributed their views to the American Psychiatric Association’s comment on the report. The APA responded to the Vision Commission report by saying that the Commission failed to improve the MOC process for physicians.

In 2018, the APA created a standing committee under the Council on Medical Education and Lifelong Learning to examine ongoing issues related to well-being and burnout. The committee is currently reviewing the data on burnout collected by the previous workgroup, analyzing data from over 2,500 psychiatrist responses to the Oldenburg Burnout Inventory. The committee is also looking closely at how wellbeing and burnout issues affect minority/underrepresented psychiatrists as well as Early Career Psychiatrists.

A Standing Committee on Innovation under the Council on Medical Education and Lifelong learning was approved by the APA Board in 2018. This committee seeks to identify and promote the formation of novel ideas to transform mental health care. The committee supported the APA Psychiatry Innovation Lab at the APA Annual Meeting beginning in 2019. Medimmunity, a digital platform aimed at preventing burnout among medical trainees by providing structured support groups, online resources to help build resilience, and a forum to enable students and residents to connect with colleagues was the winner at the 2019 Mental Health Innovation Lab competition. The idea is based on an in-person, support program available at Mount Sinai known as PEERS (Practice Enhancement, Engagement, Resilience, and Support).

The Council on Medical Education and Lifelong Learn‐ing reviewed actions of the Assembly related to education and provided feedback.

The AMA has an existing policy that states that MOC should not be a requirement for maintenance of licensure, hospital privileges, insurance credentialing, or employment. APA has been supportive of this policy. The Interstate Medical Licensure Compact has already released its eligibility requirements (http://www.imlcc.org/do-i-qualify/), which require individuals to “hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board.”

The Council weighed in and supported: Designation of psychiatry as primary care for any medical school scholarships requiring primary care service and medical school loan repayment subsidies for psychiatrists practicing in community mental health centers and state psychiatric facilities. The Council also weighed in on Access to Care Challenges and the Role of Residents.

The Council was provided with an update on the work of the ad hoc workgroup developing a Web-based “toolkit” to address racial discrimination against psychiatry trainees and practicing psychiatrists. The Council on Diversity and Health Equity is leading the content development. The Council discussed the focus of the project and discussed reaching a broader audience.

With input from the Council on Medical Education and Lifelong Learning, the APA’s Joint Sponsorship program allows District Branches and allied psychiatry organizations with missions aligned with the CME mission of APA to apply for continuing medical education credit from the APA for their meetings. The joint sponsorship program welcomed new groups into the program in 2019: The Ross Center, Mind to Mindful, the American Association of Community Psychiatrists and the American Professional Association, Inc. Goals of the joint sponsorship program include strengthening allied relationships and expanding opportunities, furthering educational goals, enhancing the APA learning management system, and bringing in new learners.

The Council initiates nominations for APAs education awards, the Nancy C.A. Roeske, M.D., Certificate of Excellence in Medical Student Education, Irma Bland Award for Excellence in Teaching Residents, and the Vestermark Psychiatry Educator Award recognizing excellence, leadership, and creativity in the field of psychiatric education; in 2019 the Vestermark award was presented to Alan Louie, M.D.

The following Positions Statements were developed by CMMH/HD and approved by APA Board of Trustees from 2018 to 2019:

The following APA Position Statements were reviewed and reaffirmed by the CMMH/HD from 2018–2019:

The Joint Meeting of the CMMH/HD and the Assembly Committee of M/UR Representatives took place at the 2018 September Components. The two groups generated the following deliverables:

CMMH/HD was asked by APA’s Division of Policy, Programs, and Partnerships to review the 2019 US Joint Statement on Conversion Therapy on behalf of APA. The document was written by the Psychotherapist Association for Gender & Sexual Diversity (PAGSD). After careful review of the document, CMMH/HD voted unanimously that APA endorse the statement and recommended that PAGSD incorporate APA’s longstanding policies against conversation therapies as references/resources.

The History and Intergenerational Workgroup, composed of CMMH/HD members, have developed a trailer (click here) for the APA documentary “Looking Back, Striding Forward The 1969 Walk-in and its Legacy.” The purpose of the film is to commemorate the May 1969 walk-in of a group of Black psychiatrists who demanded that the world’s largest professional organization of psychiatrists recognize and address minority mental health needs, mental health disparities, and the racially charged sociopolitical climate in the United States. The monumental moment in APA history impacted policy and advocacy work regarding mental health disparities for decades. This documentary could eventually be put on the APA website and used for recruitment purposes of future M/UR members.

CMMH/HD is on the final leg of the Stress and Trauma toolkit Due to the Current Social and Political Climate before it is released publicly. The toolkit was a joint effort between CMMH/HD and M/UR Caucus Leadership to provide psychiatrists with best practices for assessment and treatment of minority and vulnerable groups who are impact by the current state of the socio-political climate. Toolkit Sections include recommendations for assessment and treatment of the following groups: African American, Asian American, Hispanic, Indigenous, LGBTQ, Muslim, Undocumented Immigrants, and Women. A section focused on the assessment and treatment of Jewish Americans has been developed and is currently in review by APA’s Workgroup on Anti-Semitism.

The Council on Psychiatry and Law has developed a position statement on civil commitment for adults with substance use disorder. This document was created in response to a renewed interest in laws pertaining to civil commitment for substance use disorders (SUDs), especially in light of the opioid overdose epidemic and a growing desire to increase access to services. The statement neither endorses nor opposes SUD commitment statutes, but it does state the conditions that should be satisfied by all SUD commitment programs. This position statement is currently being reviewed by the APA Board of Trustees.

In 2017, the Council formed a workgroup to address pharmaceutical marketing practices that have been aimed at judges and legislators relating to individuals involved in the justice system. In an earlier position statement, Treatment of Substance Use Disorders in the Criminal Justice System (2016), APA took the position that medication treatment, as offered by medical professionals in accordance with evidence-based practices, is an essential component of treatment for many individuals with substance use disorders in criminal justice settings. However, pharmaceutical marketing efforts have potentially exacerbated barriers to appropriate access of treatment by influencing the types of medication treatment offered in justice settings, especially in the case of alternative-to-incarceration programs. With input from the Council on Addiction Psychiatry, the Council on Psychiatry and Law drafted a position statement to condemn marketing efforts and pharmaceutical lobbying tactics that have employed this misinformation to argue for restrictions on the range of available medications. This draft position statement emphasizes the paramount importance behind granting treating clinicians access to the full range of medication treatments for substance use disorders, including methadone and buprenorphine, and will be submitted to the Joint Reference Committee for review at its next meeting.

Individuals with mental illness may encounter firearms restrictions more frequently given the growing number of incentives offered to states to update their NICS database input and number of Gun Violence Restraining Order laws enacted nationwide. With the evolving legal landscape, psychiatric input may be requested by individuals seeking relief from these restrictions and government agencies administering registries or relief processes. The relevant statutes are often unclear as to what information should be offered by a psychiatrist, so the Council drafted a resource document offering guidance to general psychiatrists faced with these requests. The Council’s draft resource document highlights several important factors a general psychiatrist should take into consideration before undertaking the task of certifying a patient’s fitness for firearm possession. These factors include limitations on knowledge, time, and resources, liability considerations, performing evaluations in a potential tension-filled context, and the impact on the therapeutic relationship. The document also outlines two different types of statements – limited and expanded—that psychiatrists can make depending on the extent to which they feel qualified to offer an assessment. This draft resource document will be submitted to the Joint Reference Committee for review at its next meeting.

The role of guardians in consenting to psychiatric treatment—especially inpatient psychiatric hospitalization—for persons with mental illness has become increasingly complex and nuanced across states. In some states, a judicially appointed guardian may consent to psychiatric hospitalization or other mental health treatment, whereas in other states the only route for psychiatric hospital admission is through involuntary civil commitment. In order to ensure timely access to treatment balanced by protection of a vulnerable population, the Council drafted a position statement to guide the authorization of treatment for persons with mental illness by a guardian, health care agents or other legally authorized surrogates. This draft has resulted in further debate and discussion, and the Council will continue to work on what direction to take regarding this issue.

The Committee on Judicial Action, chaired by Dr. Marvin Swartz, is a component of the Council that considers and recommends APA involvement as a friend of the court in cases at every level of the judicial system and covering a range of issues. This year, APA coauthored an amicus brief to the U.S. Supreme Court in the case of Kahler v. Kansas, supporting the recognition of an insanity defense broad enough to allow meaningful consideration of the impact of serious mental disorders on individual culpability. The Committee recently recommended joining an amicus brief in the case of Stewart v Azar, asserting that Kentucky’s new work requirements for Medicaid Beneficiaries will not improve the health of the Medicaid Beneficiaries, and in the case of Texas v United States, describing why, under proper analysis, the individual mandate is severable from the remaining provisions of the Affordable Care Act. The Committee is also in the process of writing an amicus brief in the case of Kahler v Kansas, which involves the constitutionality of the insanity defense. The Committee also joined an amicus brief in the case of Moore v. Texas, asserting that an accurate diagnosis of intellectual disability requires clinical judgment based on a comprehensive assessment of three criteria: (1) general intellectual functioning; (2) adaptive functioning in conceptual, social, and practical domains; and (3) whether the relevant deficits were onset during the development period.

The Council continues to work on an array of topics, including evaluation and restoration of competence to stand trial, stalking and intrusive behavior by patients toward psychiatrists, child commitment, and voluntary and involuntary hospitalization. Members of the Council have also formed a workgroup with members of the Council on Addiction Psychiatry to address issues at the intersection of law and addiction, including supervised injection sites and assuring the appropriate care of pregnant and newly-delivered women with substance use disorders. The Isaac Ray Award Committee and Manfred S. Guttmacher Award Committee each report to the Council. The Isaac Ray Award recognizes a person who has made outstanding contributions to forensic psychiatry or the psychiatric aspects of jurisprudence; it was awarded to Dr. Peter Ash in 2019. The Manfred S. Guttmacher Award recognizes an outstanding contribution to the literature of forensic psychiatry; it was awarded to Drs. Jacob Holzer, Robert Kohn, Patricia Recupero, and James Ellison for editing and authoring Geriatric Forensic Psychiatry: Principles and Practice. Both committees are in the process of selecting their 2020 recipients and selections will be submitted to the Council for approval during the September Component Meetings.

The CMHIT works on topics related to the use of technology in clinical practice. Recently, the committee has focused on developing resources to assist members in meeting requirements for federal pay-for-performance or pay-for-reporting programs and is providing input to the Centers for Medicare and Medicaid Services’ (CMS) on its proposed rule on Promoting Interoperability among electronic health records for the 2020 Fiscal Year. The Committee recently provided feedback on the Office of the National Coordinator for Health Information Technology’s (ONC) 21st Century Cures Promoting Interoperability and Information Blocking Notice of Proposed Rule Making. Comments focused on the impact of the information blocking provisions within the rule on psychiatric care, as well as other proposals focused on the new definition of “Electronic Health Information.” The Committee also submitted comments to the ONC regarding interoperability and administrative burden for Information and another proposed rule policies.

The Committee commented on behalf of the APA on the Food and Drug Administration’s (FDA) precertification program for software as a medical device (SAMD). These comments detailed several concerns regarding the policies and procedures that would allow software developers to regulate themselves regarding the utility, efficacy, and safety of mental health and substance use disorder software applications. Furthermore, the letter recommended that the FDA refer to APA’s Mobile App Evaluation Model for the type of standards that should be used during the precertification process. APA also offered to recommend APA member subject matter experts to participate in the development of future iterations of the precertification process.

The CMHIT is expanding the ability of the APA to provide advice about current mobile mental health apps by developing the APA App Advisor. To expand the App Advisor’s capability beyond the current Apps Evaluation Model, the Committee will appoint volunteer-experts to a multistakeholder expert panel. This panel will conduct a review of potential standards applicable to apps. The APA released a public call for nominations to be submitted by August 2019. The expert panel will include member-psychiatrists, other mental health providers, software developers, informaticists, medical residents, and patients with lived experience of mental illness. Training and reviews will begin approximately the first week in October, and the APA will host a meeting of the group in early November.

Through collaboration between APA’s member-experts, members of the CMHIT and the Committee on Telepsychiatry will review content on psychiatry.org with the goal to build a “Digital Health Hub.” The hub’s objective is to connect members to resources posted on psychiatry.org.

The Committee on Practice Guidelines continues to focus on developing evidence-based practice guidelines to assist psychiatrists and others with clinical decision-making. The guideline writing group, chaired by Dr. George Keepers, is finalizing the newest Practice Guideline for the Treatment of People with Schizophrenia. The recommendation statements include psychopharmacological and psychotherapeutic treatments. This guideline is based on an AHRQ systematic review plus additional published meta-analyses. The draft version of this guideline was available for public comment through the end of June 2019. The CPG anticipates receiving approval by the APA Assembly and Board of Trustees this fall after review and possible incorporation of public comments. Additional resource materials will be published with the guideline, including an online CME vignette; family/care provider information; and provider summary/teaching slides.

Currently, there are two other assembled Guideline Writing Groups. The first writing group, chaired by Dr. Victor Reus, is working on the guideline for the treatment of bipolar disorder based on an Agency for Healthcare Research and Quality (AHRQ) systematic review, along with supplemental reviews and an expert survey.

Chaired by Dr. Catherine Crone, the second writing group is working on a guideline for the treatment of eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, night eating syndrome, avoidant/restrictive food intake disorder) based on an expert survey and a systematic review completed by the APA with Doctor Evidence, a systematic review company.

Upcoming systematic reviews for guidelines on the treatment of borderline personality disorder, delirium, and treatment-resistant depression are in the pipeline.

The CQPM focuses on matters related to nationally implemented quality measures that impact psychiatrists and their patients, as well as psychiatric quality measures that may be used by other health care providers who diagnose and treat individuals with mental and/or substance use disorders.

With support from the CQPM members, the APA has begun to outline quality measures that are patient-centered and clinically useful. The CQPM has started to prioritize topics for quality measurement. This will provide the CQPM with a strategy to provide comments to quality measure developers (e.g., Mathematica, RAND, etc.); the National Quality Forum; and federal and state policy makers and quality program administrators who rely on quality measures as tools to operationalize the goals and strategies set forth by national and state regulations.

In addition, this prioritization effort will aid in the drafting of APA’s comments during future public comment periods for CMS quality programs (Medicare and Medicaid). This includes CMS’s Inpatient Psychiatric Facility, Long-Term Care Hospital Quality Reporting Programs, the Medicare Shared Savings Plan Quality Program; the Merit-based Incentive Payment System (MIPS); and other quality measures developed and/or used by other entities separate from the government and government contracts.

The first round of the CQPM’s prioritization process resulted in quality measure topics being defined for inclusion into APA’s successful application for measure development funding awarded in September 2018. The funding supports the APA Measure Development Initiative. Among the responsibilities of the CQPM is the oversight of measures developed by APA.

The Committee also developed a position statement, “Utilization of Measurement Based Care” that was approved by the Board of Trustees in December 2018. This position statement supports the development and implementation of measurement-based care for psychiatrists and other health care providers who treat individuals with mental and/or substance use disorders.

Several workgroups report to the Council. The Patient Safety Workgroup continued their efforts this past year on a variety of safety issues, such as the development of definitions for patient observation and refinement of case studies for use in mock root-cause analyses for psychiatric training programs. Under the Council’s charge, they are also examining an action assigned by the JRC that specifically focuses on patient safety and clinical environment workflow prior to an inpatient psychiatric facility’s (IPF) construction or renovation. This has importance for mitigating ligature-point and other self-harm risks in this care-setting.

The Standards and Survey Procedures Workgroup and other APA member-experts addressed accreditation program policy updates and implementation of behavioral health standards, like those of The Joint Commission (e.g., National Patient Safety Goals on Suicide Prevention), URAC, and others.

Two other workgroups formed this year are:

The Council on Quality Care, with support from its component groups, participated in several internal and external expert panels this year. For example, the Council, including members from the CQPM, participated in strategic discussions on continued development and updates to APA’s mental health registry (PsychPRO). They also served on advisory panels to formulate recommendations for the quality measures included in the 2020 Medicaid Core Sets (for children and adults). The Council on Quality Care has been successful in achieving multiple appointments on external quality measurement panels and accrediting organizations’ decision-making bodies, and the National Quality Forum-convened National Quality Partnership’s Serious Mental Illness and Social Determinants of Health Data Integration Action Teams. These multistakeholder panels are responsible for defining national quality measurement strategies, developing meaningful quality measurement tools, recommending appropriate use of quality measures and how institutions will be surveyed for behavioral health care. These appointments afford APA an authoritative voice in the national quality enterprise.

The Council continues to help guide and support the refinement and scaling of APA’s Mental Health Registry, PsychPRO. Following the completion of 2018 MIPS reporting, PsychPRO staff began the process of refreshing participant dashboards with 2019 data as well as onboarding new participants for 2019. The newly configured dashboards provide participants with quality measures data for tracking and improving performance throughout 2019 in preparation for reporting at the top of 2020. New participant agreements have been received from 55 practices since the beginning of 2019. Based on recruitment rates from previous years, we expect to receive a total of approximately 100 additional agreements through September 2019, when registration closes for the 2019 reporting period.

PsychPRO staff worked to meet the numerous requirements necessary to remain a certified QCDR throughout the year, including the submission of Data Validation Plans for 2018 that were accepted and approved by CMS on June 5, 2019.

Outreach strategies aimed at increasing registry participation beyond what was seen for MIPS reporting are currently being implemented. These strategies include a rollout of marketing and promotional efforts including but not limited to Google Ads and social media. Postcard mailout campaigns will target non-APA member psychiatrist and other behavioral health providers.

PsychPRO continues to work with various vendors to identify PRO modules that offer superior user experience in order to expand functionality for practices focused on measurement-base care (MBC). The current focus on MBC by various regulatory and accreditation bodies means providers in the field will be seeking solutions for efficient and effective implementation of MBC processes. PsychPRO is ideally suited to deliver this functionality as well as provide for tracking and improving patient care using patient-reported data generated with MBC processes.

For more information about the Registry, please go to www.psychiatry.org/psychiatrists/registry.

Committee on Research Training: The Council’s Work Group on Research Training, chaired by Charles Nemeroff, M.D., Ph.D. and Steven Siegel, M.D., Ph.D., met to discuss the outcome of the 2019 Research Colloquium for Junior Psychiatrist Investigators (Colloquium) and plans for the 2020 Colloquium. The Colloquium continues to be jointly funded by a National Institute on Drug Abuse (NIDA) R-13 grant, the APA Foundation (APAF), and through our partnership with the American College of Neuropsychopharmacology (ACNP) and the Society of Biological Psychiatry (SOBP).

The 2019 Colloquium was a two-day event held on Saturday, May 18, and Sunday May 19 at the APA’s Annual Meeting in San Francisco. Day one of the event saw representatives from APA/APAF, NIDA, ACNP, and SOBP present on work-life balance, career trajectory, mentorship, research training, and funding opportunities to early research career (ERC) psychiatrists. This experience was augmented by a social sponsored by Colloquium co-chair Steven Siegel, M.D., Ph.D., and the University of Southern California on Saturday night, giving participants the opportunity to talk outside of Colloquium hours.

On day 2 of the Colloquium, awardees were divided into 2 tracks: Track 1 included ERC psychiatrists in the beginning stage of developing area(s) of research interest and needed mentorship in doing. Track 2 included ERC psychiatrists who had identified one or more clear research areas of interest but needed mentorship in moving forward to develop a K-award project or finetuning their research portfolio. Participants were further divided into five different research areas including Alcohol, Pain, and Substance Abuse Research; Clinical Psychobiology; Health Disparities and Health Services Research; Molecular, Translational, and Neuroscience Research; Treatment from Psychopharmacology and Psychotherapy to Neural Strategies for small group breakout sessions with their peers and team mentors.

This year, 47 senior psychiatric research mentors including Drs. Wilson Compton, John Krystal, Nina Kraguljac, Anand Kumar, Carolyn Rodriguez, and James Potash from the Council on Research took part in the event. Twelve biostatisticians/methodologists participated and provided valuable perspective often unavailable to young researchers. The 2019 panel of statisticians originated from APA (3), Stanford University (2), University of California in Irvine (1), University of California in San Francisco (1), University of California in San Diego (4), and the 2017 Psychiatric Research Fellow Adrienne Grzenda from the University of California Los Angeles (1). The Work Group hopes to continue its efforts to include a panel of statistical and methodological mentors to help senior psychiatric researchers in the mentorship of Colloquium awardees.

APA Past President (2016–2017) Maria Oquendo, M.D., Ph.D. and Bernardo Ng, M.D., chair of the APA’s Council on International Psychiatry, continue to lead the effort to expand the Research Colloquium to include more international ERC psychiatrists. Six international mentees from Brazil (2), Colombia (1), Japan (1), and France (2) were invited to attend this year’s Colloquium. International mentees were selected and sponsored by their institution, country’s psychiatric association or branch of SOBP, or were self-funded.

Currently, we are working with our ACNP partners to plan a half-day program at the ACNP Research Mentorship Booster Session, which will be held on December 7, 2019 during the organization’s Annual Meeting in Orlando. All Colloquium awardees are invited to attend the ACNP booster session. Simultaneously, we are preparing for a new cycle of 2020 Research Colloquium applicants and began promoting this even in July 2019. Plans to continue the research mentoring experience for the Colloquium awardees, including quarterly post-Research Colloquium webinars and attendance at the ACNP and SOBP annual meetings, are currently underway.

The Award for Research, the highest award for research given by the APA, was presented to Stephen Strakowski, M.D., on May 22, 2019, during his award lecture on “Brain Changes at the Onset of Bipolar Disorder” by APA’s past-president (2016–2017), Dr. Maria Oquendo. In addition, the Judd Marmar Award, established in 1999 to honor an individual who has made a substantial contribution to advancing the biopsychosocial model of psychiatry, was presented, by APA’s current president, Dr. Bruce Schwartz, to Kerry J. Ressler, M.D., Ph.D., on May 22, 2019 during his award lecture on “Modulating Aversive Memories in Psychiatry: From Rodents to Humans.”

Several other prominent researchers were acknowledged for their outstanding contributions to psychiatry and psychiatric research during the 2019 Early Research Career (ERC) Breakfast held May 21, 2019: Godfrey Pearlson, M.B.B.S., M.A., Yale School of Medicine, received the 2019 APAF/American Association of Chairs of Departments of Psychiatry Research Mentorship Award; Manpreet Singh, M.D., Stanford University, was the recipient of the 2019 Blanche F. Ittleson Award for Research in Child and Adolescent Psychiatry; and the mentor/mentee team of Dost Öngür, M.D., and his trainee, Cagri Yuksel, M.D., of McLean Hospital, received the Kempf Fund Award for Research Development in Psychobiological Psychiatry. During the ERC Breakfast, Alison Hwong, M.D., Ph.D., a PGY-3 Psychiatric Resident at the University of California San Francisco, was acknowledged as the recipient of the APAF Psychiatric Research Fellowship.

A. John Rush. M.D. received the 2019 APA Health Services Research-Senior Scholar Award, and A. Robinson Williams M.D. received the 2019 APA Health Services Research-Early Career Award.

Chair: Joshua Morganstein, M.D. The Committee on Psychiatric Dimensions of Disaster coordinated with the APA Communications Department to reach out to the district branches and state associations impacted by recent tragic events including, but not limited to, the volcano eruption in Hawaii; wildfires in California; hurricanes in the Gulf of Mexico and along the east coast; and shootings in Pennsylvania, Maryland, California, and Toronto. Committee chair Dr. Morganstein, and former chair Dr. Ursano, visited APA Administration Headquarters to discuss priorities for the committee, including ongoing enhancement of networking during disasters, the development of educational resources, and potential funding sources for disaster-related training opportunities.

This Workgroup, chaired by Charles B. Nemeroff, M.D., Ph.D., generated three manuscripts, which have been reviewed and approved by the Joint Reference Committee (JRC) and Board of Trustees (BOT), and will be submitted for publication. These manuscripts are as follows: “Amyloid and Tau in Alzheimer’s Disease: Biomarkers or Molecular Targets for Therapy,” “A Review of the Evidence for Using Hormonal Strategies in the Treatment of Depression,” and “The Use of Social Media in Recruiting Participants for Mental Health Research Purposes: A Systematic Review and Best Practices Report.”

The Workgroup provided an overview of recent initiatives, including the examination of hormones in the treatment of depression, the use of psychedelics as therapeutic agents, and the role social media plays in clinical research. Draft manuscripts of these topics will be submitted for critique and approval by the Council on Research, JRC, and BOT.

The Workgroup also successfully led the Presidential Symposium during the 2019 Annual Meeting that focuses on the state of biomarkers in psychiatry. Lastly, members expressed interest in studying the clinical utilities of biomarkers for Alzheimer’s disease, early developmental markers of schizophrenia, biomarkers of autism spectrum disorder, and machine learning for psychiatrists.

The DSM-5 Steering Committee, its Subcommittee on Minor Changes, and its Review Committees continue to be active since the last report in the Fall of 2018. At the APA Annual Meeting in San Francisco, the Steering Committee approved six minor changes. Two proposals are under review by their relevant Review Committees, who have recently submitted recommendations to the Steering Committee. The Steering Committee had requested additional information for three proposals prior to additional consideration for referral to the appropriate Review Committees. One proposal was approved by the Steering Committee; it was posted for public comment and is undergoing additional review. In addition to these active proposals, a consensus workshop was held on June 3 in New York City to determine the agreement on the inclusion of a set of diagnostic criteria for grief in Section II. A set of draft criteria was developed at the workshop, and testing of validators (reliability, validity, clinical utility, etc.) was conducted using various databases. Results were collected in September.