Presentation on theme: "Mollie Herman Nathan Sharer"— Presentation transcript:
1Trying to summarize state licensure laws for psychologists: Burial by grains of salt Mollie HermanNathan SharerPresented by Mollie Herman at the annual ACCTA conference, Baltimore, 2012
2Special 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
3The Tenth Amendment to the US Constitution (part of the Bill of Rights) Ratified December 15, 1791The 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
4Licensure laws vary on numerous dimensions: Number of hours of experience required for licensureWhat 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 timeWhether interns or postdocs need a certain number of direct service hoursIf and how direct service is defined
5Other professionsLawyers: 28 states do not have reciprocity agreements (Black, 1994)Doctors: frustration about licensure mobility, esp with new technologies like telemedicine (Silverman, 2000)
6Psychology’s efforts to ease mobility: The EPPP ASPPB developed the EPPP – first used in 1965General agreement that licensure requirements should include:two years of supervised experiencedoctoral degreepass the EPPP
7But the EPPP does not solve the problem of…. Differences in state laws regarding education and experience requirements for licensure eligibility
8Other efforts by ASPPB: Agreement of Reciprocity State accepts another state’s determination of licensure eligibility regardless of different requirementsIn the 15 years of the Agreement of Reciprocity’s existence, only 12 jurisdictions have joined
9Other efforts by ASPPB: The CPQ Certificate of Professional Qualification (1998) (ASPPB, 2010a)Meet certain educational and experience qualificationsLicensed in the US or CanadaIn practice for at least five yearsNo history of disciplinary actionthey can apply for a CPQCan apply for CPQ which facilitates licensure in states that accept the CPQ (so far 52 of ASPPB’s 63 jurisdictions)Not universally acceptedNeed 5 years experience
10Other efforts by ASPPB: Inter-Jurisdictional Practice Certificate (IPC)temporary care across state linesBut doesn’t address issue of non face-to-face treatment made possible by technological advances
11Problems still persist Example: Maryland allows immediate licensurePennsylvania requires 1 year of postdoctoral experience… BUTPennsylvania will not count supervision that has been paid for
12Even 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 grantedASPPB recommends that 1 year occur after degree is granted
14Phase I Procedure Recruited ACCTOIDS from the listserv 35 people from numerous states (including this paper’s authors) investigated 50 states plus DCEach researcher was provided with a questionnaire and was asked tolook at the Handbook of Specific Licensure Requirements by State hosted on the ASPPB website and state psychology licensure websitescontact the state licensing boards for clarification of discrepancies or to provide information that was omittedthe completed questionnaire to the authors.Complete a brief Survey Monkey survey
15Phase 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:
16Enter… Phase IIAs completed questionnaires came in and authors compared them to ASPPB Handbook and state websites, quickly became clear that everything was UNCLEARMany of the regulations were confusing and could be interpreted in different waysAlso, some items from the Phase I questionnaire were open to interpretation
17Phase II ProcedureAdditional volunteers recruited from ACCTA (and one extremely dedicated member stayed on from phase I! – thanks, Sarah!)Also invited TUCC staff to help outTen researchers investigated 50 states plus DCRepeated the first two steps in phase one and then checked their findings against phase one findingsTried to rectify discrepancies with further researchCompleted Survey Monkey survey for each state researched
18Phase 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)
19Where 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 upEndless loop: doing research, becoming confused, seeking clarification, making a decision, and then, upon double- checking, becoming confused again.
20Mission ImpossibleThis 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
21Summary of licensure laws Sent around on ACCTAMistakes found within minutes of sharingMixed feelings about sharing – so many inaccuracies
22Results: Responsiveness of licensing boards 35% in Phase I and 14% in Phase II attempted to contact the state boardMostly, licensing boards responded quickly;but in phase one, 19% never heard back from the boardin phase two, 19% had to wait over two weeks for a response, and another 19% never heard backSome difficulties reaching the board: broken links on ASPPB website, wrong contact provided
23Results: Helpfulness of licensing boards In phase one, 21% , and in phase two, 72% of researchers remained confused after communicating with the boardComments about contact with boards:quick responses, patient listening, thorough feedback“vague”, “confusing”, and “inconsistent” responsesMy experiences with Maryland
24Results: Discrepancies between ASPPB Handbook and state websites Something weirdApproximately 50% of the researchers in Phase one found discrepancies.Approximately 30% of the researchers in Phase two found discrepanciesThey were all looking at the same informationThere were discrepancies in identifying discrepancies!
25Results: 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.
26Places where discrepancies were most frequently found between phases I and II Number of hours required for licensureWhether pre-doctoral hours count toward licensureWhether an internship is requiredState law changes not reflected on ASPBB’s websiteWhether a supervisor needs to be licensed (as well as where and for how long)Time limits to accrue hours.
27Respondent comments about doing this research. 60 responsesoverwhelmingly negativemost frequent words:“difficult”“frustrating”“time consuming”Other words:“tedious”“unclear”“uncertain”
28But 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 helpfulThere are clearly differences between states regarding accuracy and accessibility of information
29Implications of this mess Costs to the publicRestricts 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 awayDifficulty with emergency resources in case of disastersObstacles to telepsychology and other new technologiesCosts to professionalsTrainees can go crazy trying to figure this stuff outTraining programs can go crazy trying to figure this stuff outPsychologists who wish to relocate or expand their practices can encounter bureaucratic obstaclesSeemingly arbitrary differences can have enormous impact on the ability of professional psychologists to practice where they want to practice
30Recommendations: 3 levels Ascend in realism, descend in degree of solving the problems1. Dream: would solve the problems, but unlikely to happen2. Improvements: could be within reach, but not without a lot of work3. Coping: manages the current problem
31The 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 standardResearch 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?)
32The Improvement LevelState boards provide thorough, accurate, and up-to-date information about their licensure lawsConsistent and easily navigated design for state board websitesASPPB Handbook is also accurate and up-to-date and expands to include:Restrictions on eligible supervisors based on their years of licensureWhether a state has particular requirements for the proportion of experience that is direct serviceState board representatives be better informed of the issues related to psychologist licensure in their stateAllows them to accurately complete ASPPB questionnaires for handbookAllows them to respond effectively to direct inquiries
33The Coping LevelMaintain healthy skepticism about licensure information; get information in writingTrainees make conservative choices regarding how and when they gain professional experiencesWhenever possible, choose internship supervisors who have been licensed for at least three yearsObtain similar postdoctoral supervisionDoctoral training programs and internship sites provide informed consent about licensure issues to potential students and interns
34FROM 2012 ACCTA SURVEY: Supervisors Required to be Licensed for…
35FROM 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 eligibility36% do not
36Discussion 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?
37ReferencesAmerican Psychological Association (2010). Model Act for State Licensure of PsychologistsAdopted by Council as APA Policy 2/20/ Retrieved fromAssociation of State and Provincial Psychology Boards (2010a). ASPPB Model Act forLicensure and Registration of Psychologists. Retrieved fromAssociation of State and Provincial Psychology Boards (2010b). Obtaining a License. Retrieved fromAssociation of State and Provincial Psychology Boards (2010c). The Association of State and Provincial Psychology Boards (ASPPB) Handbook of Licensing and Certification Requirements. Retrieved fromBlack, A. (1994). Canadian lawyer mobility and law society conflict of interest. FordhamInternational Law Journal, 18, 1.Commonwealth of Pennsylvania (2012). Supervisor requirements. Retrieved fromDeMers, 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), doi: /Hess, H. F. (1977). Entry requirements for professional practice of psychology. American Psychologist, 32(5), doi: / X
38Marques, T. (2012). Europe overhauls physician mobility regulations 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 Retrieved fromNational Council of State Boards of Nursing. (2012). Nurse Licensure Compact. Retrieved from https://www.ncsbn.org/nlc.htmNew York State Education Department. (2009). Regulations of the Commissioner. RetrievedfromReaves, 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 ). Washington, DC US: American Psychological Association. doi: /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), doi: /Schaffer, J.B. & Rodolfa, E.R. (2011). Intended and unintended consequences of state practicum licensure regulation. Training and Education in Professional Psychology, 5(4),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),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),