nyspa task force on licensure for - New York Association of School

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NYSPA TASK FORCE ON LICENSURE FOR
SUBDOCTORAL SCHOOL PSYCHOLOGISTS
December 28, 2007
Task Force Members: June Feder, Ph.D. (Chair,),Larry Bake, Ph.D., Richard DioGuardi, Ph.D.,
Rosemarie Flanagan, Ph.D., Eric Garfinkel, Ph.D, Jerry Grodin, Ph.D., Rita Perlin, Ph.D., John Stokes,
Ph.D., Dianne Polowcyzlç Ph.D & Rudy Nydegger Ph.D. ex-officio,)
.
Executive Summary
The recent CMS ruling limiting reimbursable services for Medicaid- eligible students in
New York schools to providers holding credentials which would qualify them to provide
the same services outside the school setting, has led to a push by NYASP for passage of
its long-standing bill on licensure for subdoctoral school psychologists for independent
practice. In recognition of the potential impact of this on both psychological services in
schools and the practice of psychology in New York, Dr. Dianne Polowczyk instituted
NYSPA’s Task Force on Licensure of Subdoctoral School Psychologists in November to
explore ways to address the Medicaid problem and propose an organizational position on
the issue of licensure.
Based on an investigation of APA and NYSPA policy, review of Medicaid
reimbursement procedures in other states and for other groups of providers in New York
schools and analysis of NYASP’s proposed bill, the task force recommends opposing the
legislation.
While the task force recognizes the critical importance of maintaining quality
psychological services, supporting the invaluable work of school psychologists for New
York public school students and retaining critical funding to schools for these services,
the investigation it undertook revealed other viable solutions to address the problems
created by the CMS ruling while circumventing a range of negative consequences.
Options addressed include in-school only licensure, direct supervision of non-doctoral
school psychologists by licensed school psychologists and strategies to increase the pool
of doctoral level licensed psychologists available in schools. In our view, these
alternatives would serve to maintain funding to schools without, at the same time,
sacrificing standards of psychology practice in the community which have long served
the public interest and giving rise to other potential risks such as loss of qualified
psychologists from schools and diminution of the quality of school psychological
training.
Statement of Position
In a recent Centers for Medicare and Medicaid Services (CMS) ruling, which redefined in
several areas criteria for reimbursement of in-school services to Medicaid- eligible
students, it was stipulated that counseling could not be billed unless providers of those
services held credentials that allowed them to “provide the same services outside of the
school.” That is, providers of in-school psychological services i.e. certified school
psychologists would be disqualified from providing reimbursable services to Medicaideligible students unless they were already licensed to practice independently in the
community. Currently, New York State law provides eligibility for licensure in
psychology to doctoral level-only practitioners.
As a result of this ruling, the New York Association of School Psychologists (NYASP)
has been aggressively advocating for the passage of its long-standing bill on licensure of
school psychologists for independent practice (which, it should be noted, they have been
actively pursuing since the late 1970’s.) In early November, 2007, the New York State
Psychological Association’s (NYSPA) President, Dr. Diane Polowczyk, established a
Taskforce on the Licensure of Master’s Level School Psychologists for the purposing of
exploring this issue and establishing the framework for an organizational position.
To date, investigation of this issue by the taskforce has involved conferral with the
American Psychological Association (APA), review of APA’s credentialing standards
and long-standing policies for professional psychology, review of NYSPA’s historical
position on licensing, exploration of policies and practices in other states re: Medicaid
reimbursement for in-school services as well as review of other potential remedies,
preliminary data gathering about the actual impact of the Medicaid ruling change on
services to students and analysis of NYASP’s actual bill with consideration about
potential consequences of its passage.
As a result of this investigation, the task force recommends opposing the legislation being
proposed by NYASP for subdoctoral school psychologists to be licensed for independent
practice by the New York State Board of Psychology. In the following sections, the task
force outlines reasons for this positions as well as proposing other perspectives about the
Medicaid ruling and ways to address problematic outcomes related to it.
• Alignment with APA policy. The American Psychological Association, which is the
sole nationally recognized accrediting body for professional psychology programs across
the country and which develops nationwide policy and standards for the profession, has
established doctoral level training as a fundamental requirement for its recommendations
to states regarding licensure in the field of psychology. In a recent draft revision of its
Model Act which serves as a prototype for drafting state legislation regulating the
practice of psychology, it is stated that “psychologists are recognized as Health Service
Providers if they are duly trained and experienced in the delivery of preventive,
assessment, diagnostic, therapeutic, intervention management services relative to the
psychological and physical health of consumers based on: 1) having completed scientific
and professional training in a doctoral degree in psychology.” NYSPA has historically
and consistently aligned itself with APA’s position on education requirements for
licensure.
• Review of provisions in other states related to Medicaid reimbursement for in- school
services. NYASP has argued that the solution to New York’s Medicaid reimbursement
issue for school-based psychological services requires independent licensure of nondoctoral school psychologists. However, in researching Medicaid reimbursement policies
for the same services in other states, we quickly discovered that two school districts in
two states - Maryland and Texas— receive reimbursement for these services by school
psychologists licensed for in school only rather than independent practice in the
community. It is1ikely to conclude that this also goes on in many other states and could
be done in New York as well. Therefore, we feel that this and other solutions to the
reimbursement problem are more viable than the push for independent practice.
Should this not be possible in New York, an alternate solution is for school-based
psychological services to be provided under the supervision of a doctoral level licensed
psychologist, mimicking a current practice in New York regarding school-based speech
services Medicaid permits billing for services provided by a licensed speech pathologist
or an unlicensed speech pathologist who is under the direct supervision of a qualified
speech pathologist. In light of this, the task force wonders why Medicaid could not make
a similar arrangement for services of non- doctoral certified school psychologists supervised by psychologists — rather than requiring the establishment of a new
professional license category.
Finally, a third option could be to enlarge the pool of doctoral level licensed
psychologists available within schools, (This could also operate in conjunction with
either of the first two proposed solutions.) Under current regulations, those school
psychologists seeking licensure must obtain supervision for their one post- doctoral
year’s requirement from a licensed psychologist employed on their site. Since, in some
school districts, these individuals may not be readily available, unlicensed Ph.D. level
psychologists may be unable to fulfill the supervision requirement. To increase the
likelihood that those seeking licensure might obtain it, it may be worthwhile for SED to
consider optional arrangements for this requirement such as supervision from licensed
school psychologists from other school districts or in the community.
• Increased risk to the public. As mentioned above, NYASP has argued that the solution
to the Medicaid reimbursement issue requires independent licensure of non-doctoral
school psychologists — meaning it wants school psychologists without a doctoral degree
(e.g. PhD, PsyD, or EdD) to be able to practice independently outside of schools in the
same way as does a New York licensed psychologist (one with a doctoral degree). As
already noted, most states restrict non-doctoral school psychologists to practice within
public school settings only. The current legislative proposal would, as written, not only
extend the domain of subdoctoral school psychology practice to the community but
would, in addition, expand the scope of that practice to activities well beyond what is
currently done within the confines of the school, such as, for example, applying DSM-TV
diagnoses. By allowing school psychologists, who currently operate under the
supervision and oversight of their employing school districts, to be free to operate
independently without any specific oversight or supervision — especially via a broad
expansion of their scope of practice, the State risks exposing the public to professionals
who are improperly trained and unsupervised. As such, we are also opposed to this
proposal due to the increased liability and potential harm to the public.
• Failure to remedy the problem and potential loss of in-school psychological services.
The proposed licensure of school psychologists does not appear likely to lead to
substantial changes in Medicaid guidelines for reimbursement of school psychological
services. First, the implementation of guidelines for the licensure of school psychologists
at this time may be dismissed as an effort to circumvent Medicaid guidelines that are
already in place. Second, the implementation of this legislation may have the unintended
consequence of having school psychologists leave the schools for independent practice.
Such migration to private practice is most likely to occur in areas which are already
underserved- an objection voiced by many school administrators in Texas when a similar
proposal was advanced in that state. Additionally, loss of school psychologists to private
practice may result in seriously negative consequences for the estimated 90% of special
education children who are not eligible for Medicaid reimbursement.
• Exacerbation of public confusion about providers of psychological services. We are
concerned that the current legislation, which proposes the title “school psychologist,” has
the potential to cause confusion for the public about psychological services. Since it is
confusing enough to the public when the term school psychologist is used in the schools
by individuals who do not meet the requirements for the title of psychologist outside of
the schools, we are concerned that this confusion will be multiplied when consumers
outside of the school setting are asked to distinguish between a “School Psychologist”
with a more limited scope of practice and a “Psychologist” whose training is “School
Psychology” with a more expanded scope of practice. In addition, the discrepancy
between practicing psychologists with doctoral level training and those without could add
to public concerns about what constitutes adequate training for competent practice. We
would suggest that the term “psychologist” be a designation reserved for doctoral level
practitioners only. Even in states with master’s level licensure, most titles for these
practitioners exclude use of the word psychologist. Examples of titles in other states are
Psychological Associate, Psychologists Associate, Specialist in School Psychology,
Licensed Educational Psychologist, Psychological Examiner, Licensed
Psychoeducational Specialist or Licensed Specialist in School Psychology.
• Conflicts between regulatory agencies about in-school psychological services. Under
the proposed legislation, non-doctoral providers of school psychological services will be
responsible to multiple authorities including building principals in the provision of
regular education services, special education directors for provision of special education
services, and Office of Mental Health for Medicaid-reimbursed services. Under the best
of circumstances, there are often difficulties that school culture presents with respect to
accommodating professional psychological services. The further fragmentation of
authority for providers of mental health services could lead to serious obstacles for
service delivery. Moreover, because the New York State Education Department has
abolished the positions of Chief School Psychologist and Chief Social Worker, there is
limited way for the school-based practitioner to address professional
concerns that may arise within the school setting.
• Diminution in the quality of school psychological training and school psychological
services. The adoption of a master’s entry level for independent practice of school
psychology is likely to have a negative impact on the numbers of professionals who seek
the highest level of credential for professional practice in school psychology. With no
incentive for achieving the doctoral degree, school psychology will increasingly become
a non-doctoral level profession within New York State. The loss of advanced training that
is brought by the doctoral level
practitioner is likely to adversely impact the availability of qualified supervisory
personnel and diminish the ability of schools to address the real mental health needs of
children. Although providing school psychologists licensure may have a positive effect
on numbers within the school, one could also envision a scenario where the most
experienced school psychologists leave the schools to enter private practice — something
that clearly would not remedy the current Medicaid problem.
Moreover, any reduction in the doctoral level supervisory staff in schools will impact
children negatively because universities that have training programs for doctoral level
school psychologists will have limited options for internship placements because the
internship supervisor must be a licensed professional school psychologist at the doctoral
level. Not only is this is a very serious concern as there is already a national shortage of
school psychologists; there may be several unintended consequences that include a
reduction in the numbers of highly trained school psychologists as well as the exit from
New York of those who need to find an appropriate internship. Either scenario will likely
result in fewer highly -trained and talented school psychologists.
On December 18, 2007, NYSPA’s Executive Committee approved the Task Force’s
statement of position for use as NYSPA’s official position until a NYSPA Council
review and vote in January.
Minority Position
DRAFT POSITION STATEMENT: NYSPA CONCERNS REGARDING
INDEPENDENT LICENSURE FOR SCHOOL PSYCHOLIGISTS
The DRAFT POSITION STATEMENT states that in accordance with standards
promulgated by the American Psychological Association (APA), the New York State
Psychological Association (NYSPA) strongly objects to the legislation being proposed by
the New York Association of School Psychologists (NYASP) for school psychologists to
be licensed for independent practice, asserting that the doctoral degree is required for the
practice of psychology.
I have given a great deal of thought to the DRAFT POSITION STATEMENT and have
prepared a few comments for the Task Force to consider.
My first concern is how best to meet the needs of children and to recognize our moral
responsibility in making sure that children receive the services they need.
We have learned that because of the Medicaid reimbursement requirements, some school
districts are hiring fewer school psychologists and more dually certified/licensed staff
such as school social workers who are licensed to practice as social workers in the private
sector. This would also apply to school counselors, many of whom have been recently
licensed under article 163 as mental health counselors to practice in the private sector.
I think we all agree that while school social workers and school counselors make
significant contribution to the well being of students, they lack the extensive training and
knowledge that school psychologists bring to the school environment and cannot
duplicate the services that school psychologists provide to students. Any reduction in the
number of school psychologists in the school system poses a real threat to the ability of
children to receive needed psychological services.
This is not the first time in recent history that the ability of school psychologists to
maintain their distinct role as school psychologists has been threatened.
A proposal was made around 2002 (which has not been discarded and so remains a
continuing concern for school psychologists) that there be a new title under New York
State Education Department (SED) teacher certification called Providers of Learner
Support Services with special preparation areas for school counselors, school social
workers, school psychologists, school attendance teachers and school nurse teachers.
These core competencies essentially usurp the role of the school psychologist by not
differentiating the role of the school psychologist from the roles of other practitioners
(school counselors, school social workers, school attendance teachers and school nurse
teachers) who provide support services to students. A significant portion of what school
psychologists do such consultation with classroom teachers and instructional intervention
is assigned equally to all of these practitioners.
The core competencies for all of the Providers of Learner Support Services can be found
in the January 9, 2002 memo from Charles Mackey, Jr. of the office of teacher
certification. Examples of the core competencies for all Providers of Learner Support
Services are listed in an appendix to this document.
The blurring of roles among the various providers of pupil services in the schools
presented a clear threat to school psychologists. The strong lobbying efforts by NYASP,
NYSPA’s School Division and APA’s Division 16 helped defeat this proposed change in
certification. However, this experience can serve as a reminder that psychologists are
vulnerable to those who wish to take on their role.
In the interest of children, we need to recognize that as a group, school psychologists are
the best trained to provide psychological services in the schools, and in the best interests
of children, we need to support them in any way we can.
We also need to remember that school psychologists are the first face of psychology to
the public. It is often due to the positive experience a student or parent or even a member
of the school staff has had in working with a school psychologist that will cause someone
to seek out a psychologist as the practitioner of choice when seeking mental health
services. We would do ourselves an injustice to interfere with this referral source.
Despite the position of APA on doctoral requirements for psychologists, some of you
may know that psychology was not always a doctoral level profession. It was not until
1956 with the passage of article 1 53 that New York State required the doctorate for
licensure, although hundreds of psychologists were grandfathered without the doctorate
under article 1 53.
The DRAFT POSITION STATEMENT goes on to note that NYSPA has some very
specific concerns about components in the current proposed legislation. These include
title, scope, educational requirements, internship requirements, and supervision
requirements.
NYASP is requesting NYSPA’s support n achieving licensure for school psychologists
and has made it clear that they are seeking licensure with a limited scope of practice. It is
my understanding that NYASP has the support of legislators and many
school/educational groups. There is a good possibility that they will achieve licensure
without the support of NYSPA.
At this point, NYASP has expressed a willingness to review title, scope, educational
requirements, internship requirements, and supervision requirements with NYSPA in
order to gain NYSPA’s support for the licensure of school psychologists. This provides
NYSPA with an opportunity for significant input to a proposed licensing bill for school
psychologists.
It is my hope that any reservations concerning the licensing of school psychologists is not
a guild issue, but a genuine desire to maintain high standards of training for
psychologists. NYSPA’s input would help achieve that goal.
NYSPA should take the time to fully deliberate this important licensure issue. Following
a thorough review by the Task Force, the Executive Committee might wish to make a
recommendation to Council. Council needs to review this with their Divisions and
Regions before voting on this. Since the membership of many of the Regions include a
large number of school psychologists, it would be most appropriate to ask for
membership input before Council votes on this issue.
I cannot help but agree with Dr. Larry Baker in concluding that licensing of school
psychologists “would not be a bad thing for psychology.” I do not see how a licensing
bill with clear and limited parameters that allowed school psychologists to provide the
same services outside the school setting that they provide within the school setting can
pose any genuine threat to psychologists.
There is a need for professionals who are both skilled evaluators and knowledgeable about
school issues to work with students and parents on school related concerns. Helping school
psychologists achieve a limited license for independent practice would not only help assure
that students receive the services they need from well qualified professionals. It would also
reflect well on the profession of psychology as a cohesive, unified profession with various
levels for the delivery of service.
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