American Psychological Association

119th Annual Convention
Washington D.C., August 4-7 2011





Telehealth and Telepsychology Licensure –

Barriers and Possible Solutions as Psychology Adopts the Psychotechnologies




Marlene Maheu - APA 2011Licensure Panel - APA 2011

Drs.Marlene Maheu, Stephen DeMers, Dena Puskin, Joseph McMenamin, & Patrick DeLeon


Here now, it's Sunday morning and nearing the end of this year’s APA convention. Over the last few days - happily for me and others who made a point of tuning into technology, psychology, and 21st Century experience - we have witnessed this year, the beginning of the 2nd decade of the century and millennium, far greater and broader interest in areas of 'tele-psychology', technology-assisted consultative activities, and a wide rage of Internet/computer facilitated activities. More research. More access. More applications. All good. But questions remain: In terms of professional practice, is it appropriate and legal to offer regulated professional services across state lines, or 'on the Internet'? Under what circumstances? Why or why not? What are the risks - and benefits? Who wins or loses in terms of 'access'?

The various professional and ethical codes endeavor to promote 'best practice' and protect the public. That said, we live amid a tsunami of changes in everyday life experience: new research, new technologies, new applications and new needs. One can now seamlessly transcend borders of all sorts as we find - and offer - all kinds of services and products. Some practitioners see this as a godsend, others are wary of 'doing something illegal' or jeopardizing one's license or insurance, or worse. Many out there simply just 'do their thing', with and without licenses, no worries. That's the broad context.

With all the ambiguity and mixed messages about the presence or absence of license portability, legality of cross-state professional practice on the Internet, ethics and insurance issues, and the still-ongoing debate over “where Internet consultation actually takes place”, here we have the ultimate panel of experts to provide some grounded, evidence-based information.

The panel today includes government and licensing board leaders, a physician/attorney specializing in litigating professional/licensing/ethics cases, an online psychology provider/trainer, and an APA Past President- who is an attorney/psychologist who also works on staff for a U.S. Senator with a strong record in the healthcare area. They offer an informed perspective, to say the least.

Introducing the panel: Marlene Maheu, Ph. D. (chair)


The first speaker is Stephen DeMers,Ed.D., Executive Officer of the Association of State and Provincial Psychology Boards, the ASPPB, which is now celebrating its 50th year. The title alone hints at the complexity of the whole 'system' of licensing, in the US essentially a '50-state octopus' [my term] with 50 sets of law and regulation, local and regional professional boards, and myriad ethical codes. Here to sort some of it out we have a distinguished panel of experts.

Stephen T. DeMers, Ed.D.
TelePsychology Practice Within A Regulatory Minefield: Outdated, Inconsistent and Inadequate Rules Across States & Provinces


So what is the ASPPB? It is NOT a license board itself. Rather, it supports member boards throughout the US and Canada, and it supports the EPP (nationally accepted test of core competencies).

A brief history of psychology licensure:

-- In 1888 the US Supreme Court authorized professional licensing by States.

-- In 1892 the American Psychological Association was founded

-- In 1912 All U.S, States had Medical Practice Acts

-- In 1945 the first Licensing Law for psychologists was adopted.

-- In 1953 the APA adopted its First Ethics Code

-- In 1961: The Association of State & Provincial Psychology Boards is born.

-- By 1977 all 50 States had Licensing Laws.


Now, some key points about professional licensing in the U.S.:


Basic Facts About Licensure

* Professions are regulated by the States

* There is no 'national' License


* Most laws have transitioned from title to practice acts

"You can NOT do the things described as being within the purview of a profession."
- unless you are licensed to practice that profession.


If someone says they are a “life coach” but is providing psychological services,
they are practicing psychology, "whether they call themselves a psychologist or not."


"LICENSING LAWS ARE DESIGNED TO PROTECT THE PUBLIC, NOT THE PROFESSION"




Clearly the idea of public protection is widely shared and understood. But it is equally true that many aspects of the license system scheme, as it is now, may not be responsive in today's world, to needs of practitioners willing to provide (in new ways) nor to people seeking help (in new ways). When can one help? When must one not?

Outdated aspects of Licensing Law

The laws:

-- Assume licensees only provide services within boundaries of jurisdiction

-- Assume provider and client only interact within jurisdiction

-- Assume provider establishes a professional relationship with client including identity of all parties, treatment/service plan, fees, limits, etc.

-- Assume licensee practicing in another jurisdiction will obtain license in that jurisdiction

-- Assume licensing board has authority only over providers licensed in that jurisdiction providing services to clients in that jurisdiction

One question Dr. DeMers said he is often asked: 'How many days', or 'how long' can one can practice somewhere without a license?

Answer: It varies.

Inconsistent Aspects of Licensing Laws:

* Many, but not all licensing laws allow temporary practice by persons not licensed in that jurisdiction

* Rules for temporary practice vary

* Number of days varies from 0 to unlimited with 30 days most common

* Notification/registration with board varies from advanced authorization for specific service to no notice required

* Scope of practice allowed under temporary authority varies from consultative or forensic work to full range of psychological services

Next:

Inadequate Aspects of Licensing Law

* No clear understanding of which licensing board has jurisdiction to adjudicate complaints

* Home jurisdiction often constrained because services provided outside their boundaries

* "Visited" jurisdiction may feel responsible for consumer but may have little to no authority to discipline someone licensed in another jurisdiction

* Most licensing laws do not describe limitations, parameters, or special requirements for delivery of competent/ethical telepsychology services

So now,

"What's a Psychologist Interested in New & Expanding Models of Practice To Do?"

Option A. Simply ignore the laws since they are out of date.

Option B. Skirt laws by flying "under the radar"

Option C. Challenge the laws by flaunting unlicensed practice

Option D. Support Efforts to Update & Improve Telepsychology Provisions in Licensing Law.

And what options are there for licensing boards?


Unrealistic or Ineffective Approaches

-- Get licensed in any jurisdiction where you provide services. In DeMers' opinion, it may be an 'unrealistic' approach to tell practitioners to go out and get licensed everywhere they practice, and an unacceptable burden.

-- Practice in all jurisdictions based on your "home" license; this would be unacceptable to licensing boards and state legislators

-- Adopt a "national" psychology license.

One step toward portability may be the CPQ - the ASPPB's 'Certificate of Professional Qualifications', considered a tool for 'licensure mobility' as it may help facilitate reciprocity or acquiring a new state license. The IPC (Interjurisdictional Practice Certificate) was launched "to standardize temporary practice". ASPPB created a 'credentials bank' and is currently working with jurisdictions on Universal Application. Finally ASPPB is participating in a joint APA/ASPPB/APAIT Task Force on Telepsychology Guidelines. Their vision for the future clearly seems to embrace the need for improvement and change.

Finally, the question: "What Can I Do Now?!"

Suggestions:

1. Learn about the variations in rules and regulations across the various states related to temporary practice (there is some flexibility to practice temporarily right now)

2. Obtain nationally recognized credentials that promote mobility to facilitate relicensure & enhance recognition as a competent/ethical practitioner.

For a look at specific licensure requirements by state/province/territory, licensing board contact information, and a look at any of the forms or credentials referenced above , the link to the ASPPB website, described as 'one stop shopping' - for (free) information on licensing issues and tools:

www.asppb.net

____________


Next to present, introduced by Dr. Maheu as a longtime 'advocate for tele-health': Dr. Dena Puskin, from the US Department of Health and Human Services, Health Resources and Services Administration (HRSA).


Dena S. Puskin, Sc.D.
Nursing and Medical Licensure Initiatives: Implications for Psychologists


First Dr. Puskin reminded the audience, after the focused presentation on U.S. psychology boards, that another organization also has a stake in our state licensing board system, in this case medicine. Their licensing boards are supported collectively by the Federation of State Medical Boards.

Dr. Puskin is mindful of a diversity of arguments across a spectrum of interests from both medicine and psychology, and will be presenting here now some of the findings and recommendations made by HRSA in the document titled,
Health Licensing Board Report to Congress . [.pdf file - opens in separate window] ,

License Portability - History

First, to provide some context, Dr. Puskin provided a brief history of Congressional action in support of 'portability' as a means of increasing access to care. Milestones include:

* Health Care Safety Net Amendments of 2002, PL 107-251, Section 102

* 2006: Appropriation to implement Section 102 - authorization of the Licensure Portability Grant Program (LPGP)

* LPGP announces 3-year grant awards

* Federation of State Medical Boards (FSMB) and National Council of State Boards of Nursing (NCSBN) are the first grantees

* FSMB received a second LPGP award in 2009 and a third grant in March 2010 under the American Recovery and Reinvestment Act of 2009 [PL111-5-ARRA] to expand their program

* The Wisconsin Department of Regulation and Licensing also received funding under ARRA


License Portability - Definition

What is License Portabilty?

A system that extends the privilege to practice a health profession in multiple states through agreements that recognize individual state and territorial jurisdiction while facilitating a process for obtaining and maintaining licenses in multiple jurisdictions.

What emerged from the two LPGP grant recipients, however, are two different models.

There is the “nurse model” we’ve heard about and emulated for a number of years (as psychologists, and with endorsement by the APA). And there is a second model, very different.

The first is a Mutual Recognition Model - the NCSBN Model.

The Nurse Model is based on an interstate contract. They are licensed in their home state with a licensure privilege to practice in other “compact” states which are remote to them and 'subject to the remote states' practice laws and discipline'. Compact states continue to 'operate single licensure models.

There are currently 24 Nurse Licensure Compact (NLC) States which participate. The thing is, "it’s very hard to implement." Only the home state can take “direct action” in license complaints but remote states can issue “cease and desist” orders and/or pursue home-state license revocation.

"Disciplinary action can be taken by both the home state or the state where the patient is located at the time of an adverse incident [remote state]."

Benefits: Access! And it helps states with enforcement. It clarifies authority to practice across state lines, "simplifies and streamlines the burden of obtaining multiple licenses, thereby enhancing mobility of nurse workforce, improves access to nursing services, enhances ability of licensed nurses to respond to disasters or change in demand for services, and enhances ability of Compact states to exchange the most current and accurate investigatory information, facilitating appropriate disciplinary actions."

Challenges/Barriers: Control. Loss of authority. Cost of Implementation/Loss of Revenue. Plus union concerns about potential “strike breaking” (despite no evidence of this.)

The second model is about "Expedited License Endorsement and Administrative Simplification: the FSMB Model."

The Physician’s Model was put forth to meet different needs and priorities, perhaps, and was very extensively promoted. (As some context: aside from differences in practice considerations it is an axiom that 'Nurses do not have the financial clout of the medical profession'.) In any case, it's a different model. A look at a map with incidence of multiple-state licensure for physicians is quite compelling, with numbers ranging from the 20s to 70s, percentage-wise in terms of multi-licensure. The ease of obtaining the actual licensure (as opposed to portability) appears to be a goal which was fulfilled.

Some of the highlights of the 'Physician's Model' include Uniform Online Application (UA), a centralized credentialing system (FCVS), and - importantly - 'expedited endorsement': "a method of setting criteria to approve a valid license of another state. In general, the process accepts a license issued in another state that was verified and sets requirements for endorsing a license granted from another state".

What is the Uniform Application (UA)?

At its core, the UA "Captures basic questions of a state's license application":

-- Licensure History

-- Identification Data

-- Possible Malpractice Claims

-- Work Experience

-- Medical and Graduate Medical Education

The Federal Credential Verification Service (FCVS) is designed to provide 'primary-source verification' of personal, educational, and professional credentials. It is currently accepted by 63 of the 69 state medical and osteopathic boards. The FSMB has created a new credentialing verification, with a 'fast track' feature launched in February 2011, expediting licensure for both the applicant and the Board.

Challenges/Barriers to FSMB Initiatives:

* Cultural and historic lack of comfort in accepting the licensure process of another state;
* Lack of uniformity in criteria for awarding licenses; e.g., criminal background checks;
* Additional administrative costs associated with traditional out-of-state physicians;
* Lack of uniformity in state confidentiality laws.
* Cost of Implementation of UA/FCVS
* Lack of authority to control own budget or innovate - umbrella boards;
* Lack of human and economic resources to implement technological advances due to current substantial reductions in state budgets.


And finally, the status of the Licensure Portability Grant Program:

- The program is administered by the Office for the Advancement of Telehealth, Health Resources and Services Administration

- A new competition is anticipated for FY 2012 - subject to Congressional appropriation

- The competition will be open to all relevant disciplines

- The Announcement for grant competition is expected in Fall/Early Winter, 2011-12


Finally: An announcement of the availability of funds will be available on the HRSA website:


http://www.hrsa.gov



Marlene M. Maheu, Ph.D.
Telehealth Licensure for Practice via Internet and Smartphone: The Case for Telepsychology Education


Dr. Maheu, herself a pioneering advocate for tele-mentalhealth (especially video based) treatments, presented an overview and snapshot of Telehealth/Mental Health history, and held up as a worthy goal "a free VTC platform that is as secure and reliable as the systems funded by NIH and NIMH", after 50 years and millions of dollars spent in R & D. And... "what if that system could be as reliable as the large institutions such as the VA and the military, where they have admittance, nurses, and full IT staff to support each call? "

The answer is: we do have effective systems.

[Apropos: At yesterday's panel on
technology & psychology , Military/medical expert Timothy Lacy discussed hardware & software 'out of the box' solutions for data-collection and supervision/consultation activities, while Jon Canabria presented a tour of new software and hardware.]

Dr. Maheu has observed the progress of telehealth, and been a staunch advocate since 1995. She now promotes 'best practice' online, as director of the TelementalHealth Institute, which provides training and consultation in the practical and legal/ethical issues surrounding telehealth services.

Beyond the basics many of us are familiar with - secure video/text/data feeds, the need for HIPAA compliant hardware and software which address privacy, security, record-keeping requirements, etc. - there continue to be revolutions in technology and lifestyle, and ever-increasing interest in finding or providing quality, qualified professional services - particularly online. Online or off, both healthcare professionals and their clients are more mobile and interconnected than at any time before.

We are Re-tooling...

With onscreen images of a physician doing rounds, device in hand, Dr. Maheu noted that "everything that we do today is changing due to technology". If we choose, we can stay in the office, "but clients may demand we're available via technology". Apart from the idea of 'therapy' on tiny screens [in public?] there are many applications already suitable and in use. Now a screen shot of the Galaxy Samsung - "a small tablet that fits in the lab coat, for the ER doc." It's a big time-saver. You can call in specialty docs immediately... "So what are we doing?" (as practicing psychologists)

A quick look at Google hits for things like 'counseling' - online - gives testimony to the popularity and acceptance. And it's already abundantly clear to anyone in a populated area the extent to which people are constantly attached to their 'smart' devices.

Here we are shown a great cartoon of a man (picture this!): smart-phone in one hand, smiling, and with a 3rd hand appended to his head between his eyes. The caption has him matter-of factly explaining to another man: "I decided to have the surgery because I need the extra thumb for text messaging."

[Does this not ring true?]

Meanwhile, on our end, as current, professional and ethical service providers, Maheu asked: "Are we really doing what we need to be doing?... How many here have trained in email therapy?" [One hand]

A slide asks, 'What's the Problem?'

Well, to begin with there are the legal/regulatory/ethical uncertainties. There is 'no sheriff in town'.

Yes it's true there is "tons of data supporting efficacy, but studies typically are within hospital settings, not with individual private practitioners."

Some of the factors confronting independent rather than institutional care providers:

* No IT Staff, Nurses, Admins

* No time for it all

* Consumer Naiveté

* Consumer Deception

* Loss of Trust

* Malpractice Limitations

A long list of 'Telemental Health Guidelines & Standards' is displayed, going back to 1998 and using terms such as 'Telepsychiatry', 'Internet On-line Counseling,' 'Patient-Physician Electronic Mail', 'Technology and Social Work Practice', 'Telepsychology', 'Telemedicine', and (my favorite), "psychologists providing psychological services via electronic media" - from the Canadian Psychological Association (2009).

The APA is working on new policies, but it is expected to take another 2 years for them to be published and implemented. And there is the Australian ethical code, which may serve as a good example. Also, we as a profession, Dr. Maheu emphasizes, "are not a one-trick pony". There are many ways in which we can evolve and modernize, including coming up with new and effective self-help tools.

[Agreed! A presentation on
Computerized CBT demo'd new, & effective, evidence-based self-help and guided self-help programs, including one for depression co-written by Aaron T. Beck. Within the U.K. system, CCBT is not only allowed but prescribed as a treatment of choice!]

There are many ways in which psychologists work creatively with technology. Maheu for example partners with organizations to implement a smoking-cessation program. The program involves meeting first face-to-face and then implementing remote services. Remote, but still within the state. Maheu reflects: "It is possible to practice legally now, without violating ethics... How many out-of-state clients do we need?"

And on that note, the final presenter is introduced: Dr. Joseph McMenamin. He is a former internist/ER doc who turned from there to law, was admitted to the Virginia bar, and is now specializing in litigation, risk management, and telehealth liability law.


Joseph McMenamin, JD, MD
Mobile Health: Legal Issues for Mental Health Practice


Dr. McMenamin began with his perspective and advice: "It is important for practitioners to be aware of how members of licensing boards see themselves. They see themselves as the police. Their goal is to protect the public. "

True, "we can debate how much 'protection' the public wants or needs." There is also an underlying factor he terms The Online Pharmacy Phenomenon. It is easy to get Viagra, opiods, whatever, without any one entity claiming regulatory authority to control it.

While most psychology boards tend to be conservative, Dr. McMenamin suggests becoming familiar with one's own state's definitions . Often regulations include language where the definitions are "broad...by design". Then look at how, say 'coaching' may "come under the banner" of a profession's scope of practice.

And there's another factor: protectionism. He told a story of being (as someone 'not easily shocked') recently taken aback by a specialist colleague's 'tirade'. Speaking of territorial or protectionist considerations, this gets us into an interesting area, at least for the legal profession: 'sovereignty of the states'. We (the people) "gave power to States to avoid omnipotence of the Federal Government and its ability to tyrannize people."

Finally, "[Dr. Maheu's] point is well taken - the need to be everywhere may be overstated. Although - for example with emergencies - there needs to be some slack."

Seeming to me (still) very much a balancing act of public safety, best/ethical practice, risk management and compliance...

And now to a few reactions and thoughts from the panel's distinguished designated discussant, former APA President, psychologist, attorney, and US Senate staffer...


Patrick H. DeLeon, PhD, JD

Dr. DeLeon began by saying 'Aloha!' and then thanking the panel, saying he liked the format, including the discussion with Q & A at the end.

A few points:

DeLeon said he knows from his experience in the Senate what states can do. "Change does come - eventually."

DeLeon restated and expanded on what had been said before:

" The purpose of licensure is to protect the public. It is not to protect your practice or ward off competition. "

Given this backdrop, DeLeon recalled a time when a high failure rate on a dentistry exam sparked concern - especially as the failure was among certain groups only. Change happened - once the courts got involved. Here was an instance of the licensing body itself being reminded of the purpose - protecting citizens, not choosing who gets to be licensed for any other purpose.

Dr. DeLeon next recalled a meeting in 2000, when he was APA President. He was down South "arguing for license reciprocity" but he was faced with "passionate argument;" - This is my domain, my turf, my friends...

Does the Federal Government have the power to impact harmful licensing provisions within a state?
"Where commerce is involved... we can override states at the drop of the hat". Meaning, there are consequences when states ignore Federal regulations. Want Highway Funds? Implement speed limits. Want aviation rights? No smoking in the plane.... [Note: Dr. De Leon retired from his Senate position in 2010.]

Some thoughts on the future:

DeLeon envisions the Supreme Court getting a healthcare case and ruling that States have rights to implement their own health systems.

Court decisions can cut both ways, in terms of providers. It is not so many years ago, in the case of psychologists, that only MD's were empowered to testify as experts in mental health. That has changed, while other anachronisms remain. DeLeon reflected on a few elements in play:

       * "Every health professions has core disciplines, national exams, and shared skill areas."

       *  Under Medicaid, who can be a medical director of a hospital? Physicians and dentists.

       *  Note to psychologists (as a psychologist/lawyer) : "Lawyers think that way: 'Give me a problem and I'll fix it.'"

       * "Change takes time".

As times change, so do concepts, institutions, and terms. Remember 'HMO's'? (under Reagan). Quiet change happens, sometimes in dramatic ways: SAMSHA, for example is now talking about extending services (substance/alcohol treatment) to native Americans. And the next Surgeon General of the Army? The first female. A nurse. Now that will be a revolution in healthcare delivery.

"Years ago we would drive to watch someone's TV! Not like
Rosen's picture - texting, and iPads.... The big question was: Whose TV do we watch and what kind of hot dog should we get!"

With that, Dr. Maheu opened up the panel for a brief Q & A with the audience.

Comment: "This is the most distinguished panel on telehealth licensing I've ever seen."

Question: Where does one go to access individual state regulations?

Answer: Go to the
ASPPB Website and on the left [Quick links] choose Specific Licensure Requirements by State/Province/Territory (Handbook) To get it you need to fill in a short form - in the blank field enter 'provision of telehealth'. [Dr. McMenamin agreed that this site is 'the best first-place to look'].

Two other general references were recommended:

Center for Telehealth & e-Health Law

practicecentral.org

And now a note to those who may be contemplating practicing something, somewhere, without a license: New Hampshire and Kansas have omnibus licensing boards, and the other states have dedicated boards.

Question: Should you be doing consultation online? Psychologists need to do that!
Answer: (Dr. Puskin/HRSA): SAMSHA is now developing technical protocols.

Question: We hear about licensed professionals going online but calling what they are doing 'coaching' or 'consultation'. Some feel that is enough to avoid licensing issues. I've heard it said also that 'online services are the same as someone driving on the Interstate to meet with a doctor in a nearby state. No problem there, right?' And so, when the same patient drives 'on the Internet Highway' to seek treatment, it should be considered the same: the patient is driving somewhere and agrees that the meeting is happening in the counselor's office, 'there', or 'in Cyberspace'. Finally, there are now self-guided tools, like online CBT programs, with limited, perhaps distant, professional support. Any thoughts on any or all of all this?

Answer#1 [Psychologist/Attorney]: As for the self-guided CBT, or with a therapist, the ethical issue is that of limits of competency.

Answer #2: [Board executive - Regarding the rationales and rationalizations for declaring online communication to take place where the client 'drives' to, via the the Information Highway] "They exist in a physical place. How they get there, I don't care."

Answer #3 - DeLeon - "That's why we're in a state of evolution. "

Answer #4 - DeMers - "There are practice models. It's not the licensing boards' mission to restrict. On the other hand, if psychology dies [as it is no longer recognizable as a unique profession], there will be nothing left to license!"

"There are tremendous numbers of unserved people. I'm not against distance education. I'm against bad distance education."

Question: I was stuck by response by so many people to Hurricane Katrina. Other than the Red Cross, is there no way to vet who was actually qualified to volunteer help?

Answer: (Dr. Puskin, HRSA) - We've just completed our 3rd guide, actually. We know: "People of good will want the same thing." (To help!) In the immediate aftermath, "you have to figure out the system flow, economic flow..." In formulating guidelines, you want to develop a model to implement. We can ask, do we have a hybrid model?

QUESTION: "Where is the political will to 'step off the curb' now, as opposed to 3 or 5 years from now? What can we do now? Where is the pathway we want? We're not there to improve access to quality care! We need to remove barriers. "

ANSWER/Comments (Dr. McMenamin, Healthcare litigation/risk management) - First, to the earlier question [about responding to out of state queries as 'consultation'] - You can at least lessen the risk: 1) Issue disclaimers; 2) Keep it general

But.... "I would urge caution and avoid providing services to a place you're not licensed" Not only won't the argument about not actually being in the client's state hold, but also "you may void your malpractice insurance."

Comment (Dr. Maheu): APAIT [insurance] has a variation on this: We will not cover you - in court - if you are acting 'illegally', although they will defend you before a licensing board.

Comment (Dr. McMenamin) : "If it's a disciplinary matter, you're in double trouble." You're facing charges of both 'standard of care' violations and 'unauthorized practice'. "The impact on a jury is likely minimal in terms of license authority, but the jury may go ballistic if bad care is involved."

Comment (Dr. DeMers): And there's another variation: Some will say, there is no specific policy on telehealth so I'm not violating anything! Or, there's this theory: California cannot prosecute you from Virginia... They won't bother you so you'll just proceed as "a fly under the radar".

"I don't know one person who has been pursued by a licensing board for practicing online... but you don't want to be the poster case."

Comment (Dr. Maheu): And ... international practice? Let's say US and Canada.

Response (Dr. McMenamin): It's not likely Canada is going to come and get you, although it may be not particularly wise. In Europe actually, there is a license portability system but it needs to be applied to every country to be effective. There is a framework in place for an International treaty. [It's online, though not easy to find.] And despite the issue of license acceptance, there still may be, within the EU, requirements of getting work permits.

A few last thoughts about other countries' systems were quickly shared (e.g., Brazil), but the session's time was running out.

And for me that concludes my APA 2011 feast of fascinating events. This was certainly a panel which could definitively respond to the questions we and the general community of practitioners are increasingly asking. Definitions may be broad, institutional change may be slow, but at the same time we are immersed in some very exciting and rapid transformation all around us.

I sincerely thank the many wonderful people who took the time to share and prepare... And that is the end of my convention reports for this year, asynchronously live from Washington, APA's 119th Annual Convention.

Best Regards!

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2008 Convention Highlights:

Grand Theft Childhood | Opening | Malcolm Gladwell | College Success, Love, Hate, More | My Life With Asperger's
My Space, You Tube, Psychotherapy, Relationships... | Aaron T. Beck - 2008 | The Mind and Brain of Voters

2009 Convention Highlights:
Internet: Pathway for Networking, Connecting, and Addiction | Opening | Virtual Psychology & Therapy | Q&A with Zimbardo
Seligman: Positive Education | Future of Internet Media | Sex, Love, & Psychology | How Dogs Think

2010 Convention Highlights:
Online Support Groups & Applications | Evidence & Ethical Practice | Opening Ceremony | Sir Michael Rutter: Resilience
Group Memory | Psychology in the Digital Age | Steven Hayes: What Psychotherapists Have that the World Needs Now


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