Trying to summarize state licensure laws for psychologists: Burial by grains of salt
Mollie Herman
Nathan Sharer
Presented by Mollie Herman at the annual ACCTA conference, Baltimore, 2012
Special thanks to:
Sarah Armstrong, Cheryl Blank, Cyndy Boyd, Cindy Bruns, Daniela Burnworth, Brigid Cahill, Maria Carruba-Whetstone, Paul Castelino, Jane Clement, Rhandi Clow, Julie Corkery, Kathlyn Dailey, Kristen Davis-Johnson, Harriet Dickey-Chasins, Glade Ellingson, Pamela Epps, Betty Fletcher, Mark Forest, Tricia Hanley, Bruce Herman, Chris Hogan, Merris Hollingsworth, Karen Lese-Fowler, Peter Liggett, Jenny Lybeck-Brown, Keith Magnus, Joan Mizrahi, Rosemary Nicolosi, Jennifer Petro, Julia Phillips, Jeanne Piette, Emil Rodolfa, Felix Savino, Daniel Schulte, Andrew Shea, Meredith Shefferman, Tawa Sina, Joy Stephens, Karen Taylor, Jod Taywaditep, and Brett Vicario
The Tenth Amendment to the US Constitution (part of the Bill of Rights)
Ratified December 15, 1791
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
Licensing = state power
Licensure laws vary on numerous dimensions: Number of hours of experience required for licensure
What proportion of those hours must be predoctoral versus postdoctoral (with some states requiring no predoctoral hours, others requiring no postdoctoral hours, and still others requiring 2000 hours of each),
Whether internship and / or postdoctoral supervisors need to have been licensed for a specified amount of time
Whether interns or postdocs need a certain number of direct service hours
If and how direct service is defined
Other professions
Lawyers: 28 states do not have reciprocity agreements (Black, 1994)
Doctors: frustration about licensure mobility, esp with new technologies like telemedicine (Silverman, 2000)
Psychology’s efforts to ease mobility: The EPPP
ASPPB developed the EPPP – first used in 1965
General agreement that licensure requirements should include: two years of supervised experience
doctoral degree
pass the EPPP
But the EPPP does not solve the problem of….
Differences in state laws regarding education and experience requirements for licensure eligibility
Other efforts by ASPPB: Agreement of Reciprocity
State accepts another state’s determination of licensure eligibility regardless of different requirements
In the 15 years of the Agreement of Reciprocity’s existence, only 12 jurisdictions have joined
Other efforts by ASPPB: The CPQ
Certificate of Professional Qualification (1998) 1998 (ASPPB, 2010a) Meet certain educational and experience qualifications
Licensed in the US or Canada
In practice for at least five years
No history of disciplinary action
they can apply for a CPQ
Can apply for CPQ which facilitates licensure in states that accept the CPQ (so far 52 of ASPPB’s 63 jurisdictions) Not universally accepted
Need 5 years experience
Other efforts by ASPPB:
Inter-Jurisdictional Practice Certificate (IPC) temporary care across state lines
But doesn’t address issue of non face-to-face treatment made possible by technological advances
Problems still persist
Example: Maryland allows immediate licensure
Pennsylvania requires 1 year of postdoctoral experience… BUT
Pennsylvania will not count supervision that has been paid for
Even ASPPB and APA disagree…
In their respective model licensing acts: APA recommends 2 full time years of professional
supervised experience, both of which can occur before degree is granted
ASPPB recommends that 1 year occur after degree is granted
How the project got started
Phase I Procedure
Recruited ACCTOIDS from the listserv
35 people from numerous states (including this paper’s authors) investigated 50 states plus DC
Each researcher was provided with a questionnaire and was asked to look at the Handbook of Specific Licensure Requirements by State hosted on
the ASPPB website and state psychology licensure websites
contact the state licensing boards for clarification of discrepancies or to provide information that was omitted
email the completed questionnaire to the authors.
Complete a brief Survey Monkey survey
Phase I Questionnaire State:
Total hours required for licensure:
Minimum / maximum years permitted to accrue hours:
Is internship required by law:
Is there a specific number of hours required from INTERNSHIP? (Yes / No)
If yes, total required from internship:
APA-accreditation requirements for internship? (Yes/No)
Are there a specific number of POSTDOCTORAL hours required? (Yes / No)
If so, total required from postdoctoral experience:
Can you count non-internship predoctoral hours:
Specific percent of internship experience required to be direct service?
Definition of direct service (If applicable):
Supervisor requirements (e.g. must supervisor be licensed in the state in which the activity occurs; must the supervisor have been licensed for a specified period of time; etc.):
Any other particular requirements or important facts:
Enter… Phase II
As completed questionnaires came in and authors compared them to ASPPB Handbook and state websites, quickly became clear that everything was UNCLEAR
Many of the regulations were confusing and could be interpreted in different ways
Also, some items from the Phase I questionnaire were open to interpretation
Phase II Procedure
Additional volunteers recruited from ACCTA (and one extremely dedicated member stayed on from phase I! – thanks, Sarah!)
Also invited TUCC staff to help out Ten researchers investigated 50 states plus DC
Repeated the first two steps in phase one and then checked their findings against phase one findings Tried to rectify discrepancies with further research
Completed Survey Monkey survey for each state researched
Phase II Questionnaire:
State:
Total hours required for licensure:
Can you count predoctoral hours (including internship)toward the licensure hours requirement? (Yes/No)
What are the minimum number of hours required for internship? (Total/None/Not-specified)
How many internship hours can you count toward licensure requirements? (Total/None/Not-specified)
How many NON-INTERNSHIP, PREDOCTORAL hours (e.g. externship, practica) can you count toward licensure hours? (Total/None/Not-specified)
Is there a time limit specified in which to accrue predoctoral hours for licensure? [Yes (Min/Max)/No]
Is internship required by law: (Yes/No)
Does internship have to be APA or CPA-accredited? (Yes/No)
If no, are other specifications listed? (e.g. meet APPIC standards, meet standards of state board; be acceptable to doctoral program):
Internship supervisor must be licensed in jurisdiction in which supervision takes place? (Yes/No)
Internship supervisor must have been licensed for a specified amount of time?[Yes (how long)/No]
Specific percent of internship experience required tobe direct service?
Definition of direct service (If applicable):
Are there a specific number of POSTDOCTORAL hours required? (Yes/No)
Postdoctoral experience supervisor must be licensed in jurisdiction in which supervision takes place?
Postdoctoral experience supervisor must have been licensed for a specified amount of time?
What percentage of postdoctoral experience must be supervised by a psychologist meeting the requirements stated above? (Percent)
Specific percent of postdoctoral experience required to be direct service?
Definition of direct service (if applicable)
Where the direction changed…
One author (me) double-checked all submissions for consistency with ASPPB Handbook and state laws.
About 10 states into this process, I gave up Endless loop: doing research, becoming confused, seeking
clarification, making a decision, and then, upon double-checking, becoming confused again.
Mission Impossible
This was the point at which the authors decided that gathering truly accurate information about state licensure requirements for psychologists was impossible.
Mission changed: tell the story
Summary of licensure laws
Sent around on ACCTA
Mistakes found within minutes of sharing
Mixed feelings about sharing – so many inaccuracies
Results: Responsiveness of licensing boards
35% in Phase I and 14% in Phase II attempted to contact the state board
Mostly, licensing boards responded quickly; but in phase one, 19% never heard back from the board
in phase two, 19% had to wait over two weeks for a response, and another 19% never heard back
Some difficulties reaching the board: broken links on ASPPB website, wrong contact provided
Results: Helpfulness of licensing boards
In phase one, 21% , and in phase two, 72% of researchers remained confused after communicating with the board
Comments about contact with boards: quick responses, patient listening, thorough feedback
“vague”, “confusing”, and “inconsistent” responses
My experiences with Maryland
Results: Discrepancies between ASPPB Handbook and state websites
Something weird Approximately 50% of the researchers in Phase one found
discrepancies.
Approximately 30% of the researchers in Phase two found discrepancies
They were all looking at the same information
There were discrepancies in identifying discrepancies!
Results: More discrepancies
Nearly 50% of phase two researchers found discrepancies between their own findings and those of the phase one research.
What this means: Two professionals (many with licenses in the states they were researching) were presented with the same licensure law data and…
half the time came to different conclusions about what the law stated.
Places where discrepancies were most frequently found between phases I and II
Number of hours required for licensure
Whether pre-doctoral hours count toward licensure
Whether an internship is required
State law changes not reflected on ASPBB’s website
Whether a supervisor needs to be licensed (as well as where and for how long)
Time limits to accrue hours.
Respondent comments about doing this research.
60 responses
overwhelmingly negative most frequent words:
“difficult”
“frustrating”
“time consuming”
Other words:
“tedious”
“unclear”
“uncertain”
But not universally bad
Approximately 30% of the respondents who left feedback reported that the process for their state was not very taxing and that resources were helpful
There are clearly differences between states regarding accuracy and accessibility of information
Implications of this mess
Costs to the public Restricts availability of mental health services – even if you live
on the border of a state, can’t necessarily seek help from someone a few miles away
Difficulty with emergency resources in case of disasters
Obstacles to telepsychology and other new technologies
Costs to professionals Trainees can go crazy trying to figure this stuff out
Training programs can go crazy trying to figure this stuff out
Psychologists who wish to relocate or expand their practices can encounter bureaucratic obstacles
Seemingly arbitrary differences can have enormous impact on the ability of professional psychologists to practice where they want to practice
Recommendations: 3 levels
Ascend in realism, descend in degree of solving the problems
1. Dream: would solve the problems, but unlikely to happen
2. Improvements: could be within reach, but not without a lot of work
3. Coping: manages the current problem
The DREAM….
Nationally accepted standard for psychology licensure. all states agreed to adopt a common standard for
psychology licensure (with each state having option of state jurisdictional exam)
Use evidence to establish this national standard Research regarding the number of hours and what types of
experiences are needed for minimum competency. (e.g. currently: Iowa requires 1500 hours of experience; Florida requires 4000; any differences in their outcomes?)
The Improvement Level
State boards provide thorough, accurate, and up-to-date information about their licensure laws
Consistent and easily navigated design for state board websites
ASPPB Handbook is also accurate and up-to-date and expands to include: Restrictions on eligible supervisors based on their years of licensure
Whether a state has particular requirements for the proportion of experience that is direct service
State board representatives be better informed of the issues related to psychologist licensure in their state Allows them to accurately complete ASPPB questionnaires for
handbook
Allows them to respond effectively to direct inquiries
The Coping Level
Maintain healthy skepticism about licensure information; get information in writing
Trainees make conservative choices regarding how and when they gain professional experiences Whenever possible, choose internship supervisors who have
been licensed for at least three years
Obtain similar postdoctoral supervision
Doctoral training programs and internship sites provide informed consent about licensure issues to potential students and interns
FROM 2012 ACCTA SURVEY: Supervisors Required to be Licensed for…
FROM 2012 ACCTA SURVEY: If there are no restrictions on how long supervisors must have been licensed…
64% provide advance warning to interns about potential complications related to licensure eligibility
36% do not
Discussion
Reactions?
How do people handle this at their sites?
Has anyone had any problems with interns getting licensed elsewhere?
Any other strategies come to mind to address the problems?
References American Psychological Association (2010). Model Act for State Licensure of
Psychologists
Adopted by Council as APA Policy 2/20/2010. Retrieved from http://www.apa.org/about/policy/model-act-2010.pdf
Association of State and Provincial Psychology Boards (2010a). ASPPB Model Act for
Licensure and Registration of Psychologists. Retrieved from http://www.asppb.net/files/Final_Approved_MLRA_November_2010.pdf
Association of State and Provincial Psychology Boards (2010b). Obtaining a License. Retrieved from http://www.asppb.net/i4a/pages/index.cfm?pageid=3390
Association of State and Provincial Psychology Boards (2010c). The Association of State and Provincial Psychology Boards (ASPPB) Handbook of Licensing and Certification Requirements. Retrieved from http://www.asppb.org/HandbookPublic/HandbookReview.aspx
Black, A. (1994). Canadian lawyer mobility and law society conflict of interest. Fordham
International Law Journal, 18, 1.
Commonwealth of Pennsylvania (2012). Supervisor requirements. Retrieved from http://www.pacode.com/secure/data/049/chapter41/s41.33.html
DeMers, S. T., Van Horne, B. A., & Rodolfa, E. R. (2008). Changes in training and practice of psychologists: Current challenges for licensing boards. Professional Psychology: Research And Practice, 39(5), 473-479. doi:10.1037/0735-7028.39.5.47
Hess, H. F. (1977). Entry requirements for professional practice of psychology. American Psychologist, 32(5), 365-368. doi:10.1037/0003-066X.32.5.365
Marques, T. (2012). Europe overhauls physician mobility regulations. Canadian Medical Association Journal , 184(3), E169-E170.
Missouri General Assembly. (2011). Missouri Revised Statutes Chapter 337 Psychologists—
Professional Counselors--Social Workers Section 337.025. Retrieved from http://www.moga.mo.gov/statutes/C300-399/3370000025.htm
National Council of State Boards of Nursing. (2012). Nurse Licensure Compact. Retrieved from https://www.ncsbn.org/nlc.htm
New York State Education Department. (2009). Regulations of the Commissioner. Retrievedfrom http://www.op.nysed.gov/prof/psych/part72.htm
Reaves, R. P. (2006). The History of Licensure of Psychologists in the United States and Canada. In T. J. Vaughn (Ed.), Psychology licensure and certification: What students need to know (pp. 17-26). Washington, DC US: American Psychological Association. doi:10.1037/11477-002
Rodolfa, E., Ko, S. F., & Petersen, L. (2004). Psychology Training Directors' Views of Trainees' Readiness to Practice Independently. Professional Psychology: Research And Practice, 35(4), 397-404. doi:10.1037/0735-7028.35.4.397
Schaffer, J.B. & Rodolfa, E.R. (2011). Intended and unintended consequences of state practicum licensure regulation. Training and Education in Professional Psychology, 5(4), 222-228.
Silverman, R. (2000). Regulating medical practice in the cyber age: Issues and challenges for state medical boards. American Journal of Law & Medicine, 26(2-3), 255-276.
Tracy, E.N., bucchianeri, M., & Rodolfa, E.R. (2011). Internship hours revisited: Further evidence for a national standard. Training and Education in Professional Psychology, 5(2), 97-101.