01 Aug 2017

APA 2016 Annual Report

APA 2016 Annual Report

As a psychologist and valued member of APA, your success depends on factors that go beyond your own hard work and expertise. You also need representation on the critical issues facing all of psychology in this time of uncertainty and change. You need access to tools and resources that help you keep pace with the developments in the field. With new leadership and a renewed focus on making your membership more relevant, APA offers what you need and is meeting the promise of our mission—to advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives.

As APA’s new CEO, I am pleased to announce the availability of the 2016 APA Annual Report, which reflects the excellent work and accomplishments of APA in 2016. In prior years, the APA Annual Report was mailed to you in hard copy, but now it is in digital format and conveniently accessible anytime and anywhere, with interactive features and videos. A short, downloadable pdf featuring highlights of the digital report is also available on the APA website.

The past year has brought both progress and accomplishments, and we think you’ll especially enjoy reading about these achievements in the report:

• The year in review, including the many ways APA supported its mission by educating the public about mental health and psychology’s scientific basis and by advocating for key federal policies and legislation
• The top initiatives APA delivered for psychology and psychologists in science, practice, public interest and education through its publications and databases, value-added products and national and international programs
• The APA treasurer’s report and financial statements

I hope you’ll delve into the details of this report to learn how APA made an impact in 2016 in ways that support your career, advance psychology and improve people’s lives.

Arthur C. Evans, Jr., PhD
Chief Executive Officer
American Psychological Association

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20 Jun 2017

New Licensure Test on the Horizon

New Licensure Test on the Horizon

A new licensure test is on the horizon. What is it and why is it necessary?

The Association of State and Provincial Psychology Boards (ASPPB) announced in March that its board of directors had approved a plan to develop an additional licensure exam that would complement the existing test. The new exam, called the EPPP (Examination of Professional Practice in Psychology) Step 2, would focus on assessing skills, while the existing EPPP would continue to test knowledge.

The announcement about the EPPP-2, which may become a requirement as early as January 2019, is evoking mixed responses in the psychology community.  

"I can definitely support the idea that there is a need to test skills because there are inconsistencies in training, but I'm worried that it will be expensive and yet another hoop that students are going to have to deal with," says Christine Jehu, PhD, chair of the American Psychological Association of Graduate Students (APAGS).

For others, the announcement was primarily welcome and perhaps long overdue news. "The competency movement has been going on for 30 years in psychology, and this new test is very consistent with a number of initiatives APA has been involved with," says Catherine Grus, PhD, deputy director of APA's Education Directorate.

In 2004, for example, APA formed a task force that studied then-current practices in competency assessment within psychology and other health professions. Two years later, the group released a report recommending that psychology develop a mechanism to test knowledge, skills and attitudes. The EPPP tests knowledge, but not skills and attitudes, Grus says.

"There are hundreds of different psychology training programs and practicum and internship sites, all with different supervisors and no common standard," says ASPPB CEO Stephen DeMers, EdD. "We have to find a way to keep the process of education credible and the profession relevant."

While APA accreditation holds schools to a certain standard of education, relatively few states have licensing laws that require psychologists to graduate from an accredited school. Even if all states required graduation from an accredited program, the field still needs to develop a method of screening candidates for licensure, DeMers says. "Accreditation evaluates an entire program, but licensure depends on competency of an individual," he says.

A test of skills is also in line with competency testing models used for other medical professionals such as MDs, says Eddy Ameen, PhD, director of APA's Office on Early Career Psychologists. "Proper competency assessment is an important part of what it means to be a psychologist. It ensures that all who treat the public have a minimum universal skill set."  

DeMers hopes that the EPPP Step 2 ultimately will help psychologists increase their clout when lobbying third-party payers for reimbursement coverage and government agencies for federal programs. "I think we lose opportunities in these areas when we are not demonstrating a maintenance of competence," he says. "For that reason, I think this change is exciting and also necessary." 

The path to a new test

The ASPPB initially explored the idea of developing a skill-based exam in the 1990s when it investigated an approach called latent image testing that was touted as a method of evaluating an applicant's decision-making process during a practice scenario. It was a paper-and-pencil version of today's electronic adaptive testing, which tracks the number of correct responses and how efficiently people move through a test. ASPPB abandoned the idea because it was cumbersome and did not seem to adequately assess the complex decision-making involved in psychology treatment scenarios, DeMers says.

ASPPB revisited the concept of competency testing about eight years ago, and in 2010, appointed a task force to review the literature on the topic. The group started gathering information from other professions (such as medicine, nursing and pharmacy) that were already involved in skill-based assessments and surveyed licensed psychologists to determine the criteria for the skills testing.

The task force suggested that ASPPB move forward with developing a skill-based test that would assess competency in the following areas: scientific orientation, professional practice, relational competence, professionalism, ethical practice and systems thinking.

Who, when and how much?

While there may be advantages to updating the licensing process, ASPPB recognizes another expensive test may seem daunting to new graduates. Many new graduates already carry considerable debt and are paying multiple fees for state boards where they are applying to practice, Jehu says.

ASPPB's goal is to keep the cost of Step 2 comparable to the EPPP, which is about $700, DeMers says. This will be challenging because the new test will likely use more expensive technology than Step 1, such as computer-based simulation, taped scenarios and possibly avatars.

"There will be a lot of upfront costs, but this has to happen and it's our job to make it as low-cost as possible," DeMers says.

In addition to cost concerns, some early career psychologists question whether it is wise to wait until the conclusion of training to weed out potentially incompetent psychologists. "If the goal is to be consistent with other degree programs, then why would we wait until so much later than medical programs, which test individuals throughout their training program as a uniform national standard?" says Samantha Rafie, PhD, an early career psychologist at Bay Area Pain and Wellness Center in California.

DeMers says that once the EPPP-2 is available, it may be possible to begin offering Step 1 before internship. This would mean the first test could be given immediately following coursework when knowledge is easier to recall. This could potentially reduce the need for people to spend money on expensive test preparation materials, he says.

"Moving the first test earlier could also allow students to use loan money to help cover the cost of the test," Jehu says. "There would also be more peer support when studying for the test if students are still at school."

Another question within the psychology community is who will be required to take the test. Rafie is already licensed, and she is concerned that she would have to take EPPP-2 if she wanted to move outside of California to practice. ASPPB will recommend that its member jurisdictions not require Step 2 for previously licensed psychologists with no record of complaints or discipline, DeMers says. For those who will be seeking a license after Step 2 is required, ASPPB will recommend to its member groups that psychologists only take it once to work in any state or Canadian province.

What's next

Before ASPPB will be ready to start offering the test, the organization needs to develop a blueprint for the exam, train psychologists to write the questions and conduct beta testing. They welcome help from psychologists who are interested in writing questions for the test or beta testing it. People interested in helping can email ASPPB Chief Operating Officer Carol Webb at cwebb@asppb.org.

Although the Step 2 is a costly and time-consuming endeavor for both ASPPB and graduates of the future, Grus is optimistic that advantages of updating the testing process will be felt throughout the psychology community.

"ASPPB has to be responsive to a society that trusts psychology to be a profession that is populated by individuals who are well trained," Grus says. "I think Step 2 will establish that psychologists are holding themselves accountable and we value our profession."

By Heather Stringer


This article was originally published in the July/August 2016 Monitor on Psychology

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06 Jun 2017

Reimbursing Interns, Increasing Care

Reimbursing Interns, Increasing Care

When Medicaid pays for psychology interns' services, more people get care

It is already hard for many psychology graduate students to find high-quality internships. The fact that training programs in 34 states cannot be reimbursed by Medicaid—the government insurance program for those with low incomes and limited resources—for the work of their highly skilled interns makes it even harder. The result? Less access to care for vulnerable patients who are already among the most underserved in the nation.

At least one North Carolina internship site, for example, has already closed partly because it couldn't get Medicaid reimbursement for the services its interns provided. In states that allow Medicaid reimbursement for interns, internship sites use that money to help finance their internship programs.

"My concern is that as there is more and more pressure on internship programs to support themselves, we could be in danger of losing more," says Sally Cameron, executive director of the North Carolina Psychological Association. Traditionally, she says, clinicians did not have to worry about billing enough services to cover their salaries. But with health-care institutions facing mounting financial pressures, that has changed—in a way that could be bad news for internship programs and Medicaid patients alike.

"Not being able to bill for a qualified service by a highly trained, supervised intern could result in further losses," says Cameron.

The lack of reimbursement for interns is also bad for consumers, because fewer internship slots mean fewer providers and thus gaps in mental health care for people who rely on Medicaid, Cameron points out. The 60 or so North Carolina internship slots at sites that now see Medicaid patients—the state's 20 other internship slots are in the federal prison system, where Medicaid reimbursement is not an issue—may not be allowed to see Medicaid patients because they cannot be reimbursed for their services. There is also a quality of care issue, adds Cameron, noting that the interns who see Medicaid patients are better equipped to serve Medicaid patients well once they become full-fledged psychologists.

The North Carolina Psychological Association is just one of many state, provincial and territorial psychological associations (SPTAs) working alongside APA to push for new legislation or regulatory fixes. "Our goal is full reimbursement for interns' services, without any strings attached," says Cameron. "We want interns to be full partners in providing services under supervision."

What is at stake is access to high-quality psychological services for the more than one in five Americans who rely on Medicaid for their health care. And with the Medicaid expansion in many states as a result of the Affordable Care Act, the demand for psychological services will only grow. "In some places, clients are already waiting weeks or months to be seen," says Eddy Ameen, PhD, who directs APA's Office on Early Career Psychologists.

Meeting a growing need

Because Medicaid is a joint federal/state program, each state runs its own program, within broad parameters set by the federal government. "Programs vary tremendously from state to state," says Shirley Ann Higuchi, JD, associate executive director for legal and regulatory affairs in APA's Practice Directorate. The managed-care companies that run many state Medicaid programs—and provide services to 80 percent of Medicaid beneficiaries—may also have their own reimbursement rules.

Only 16 states currently allow reimbursement for interns in some capacity; Nevada and Texas have rule changes pending that would allow for intern reimbursement. Of those 16 states, some limit intern reimbursement to certain settings or services. In Oregon, for instance, interns can be reimbursed only for services provided in coordinated care organizations. In Colorado, interns can bill for Medicaid services provided in residential facilities and a few other settings.

APA's Practice and Education Directorates are working to increase the number of states that allow Medicaid reimbursement for interns. APA is researching state programs to determine how they function and to identify barriers, investigating possible legislative or regulatory fixes and trying to come up with a national strategy that could be used as a template for advising state Medicaid agencies considering changes. APA is also tackling the problem of the six states, plus the District of Columbia, that don't even reimburse independently practicing psychologists for services provided to Medicaid patients—a situation that also limits patients' access to mental health care.

One significant barrier that has to be overcome is the concern among some state Medicaid agencies that interns aren't competent to provide services because they aren't yet licensed. "People outside the psychology training community assume that because doctoral psychology students take their licensing exams after their internship years, these unlicensed practitioners aren't as qualified as their licensed supervisors," says Caroline Bergner, JD, a policy and advocacy fellow in APA's Education Directorate. "But interns have so much experience by the time they start their internships—between 1,500 and 2,000 hours of patient care—that they're very well-equipped to provide psychotherapy and a host of other services."

Bergner and others encourage psychologists and trainees to reach out to APA for help if they're interested in fixing the intern reimbursement problem in their states. They should also collaborate with their SPTAs, training directors, state psychology licensing boards, students and others as they begin exploring legislative or regulatory possibilities. In states that have already won the fight, the psychology community should share that story and help those in other states achieve success, too. Says Ameen, "We need champions in more states."

For more information about Medicaid reimbursement, tips on how you can help and resources, check out the Advocacy Toolkit at www.apa.org/ed/graduate/about/reimbursement/index.aspx.

By Rebecca A. Clay


This article was originally published in the September 2016 Monitor on Psychology

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04 May 2017

New CEO Talks About Future of APA

New CEO Talks About Future of APA

Just two weeks after Arthur C. Evans, PhD, took the helm of APA, he was thrust onto a stage in front of more than 450 APA staff members to talk about his vision for the association. He surprised the audience with a multiple-choice quiz about his favorite food and musical performer (lasagna and Dolly Parton, in case you were wondering) but he also sent a clear message: APA’s next chapter will be focused on making psychologists and psychology more visible to the general public.

“In my experience, people have a very limited view of psychology,” Evans said in an interview shortly after his first day as chief executive officer of APA. “They don’t understand the full range of research and science in the discipline. They should know the full impact of what we do, whether it’s in the media, in Congress or at the state level.”

Injecting psychology into the national conversation about public health and wellness is not just about treating the individual, he says, but about focusing on how psychology can have an impact on communities and society, making it relevant to people of all backgrounds.

Similarly, he says, being a member of APA is important for psychologists to feel connected and heard. “There are a lot of benefits of APA – the networking, the publications,” he said. “I’m interested in how to use the existing infrastructure and bring it into the age of Google and Amazon and Apple and make it really easy for people to benefit from all the resources we have.”

Before APA, Evans spent 12 years as commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services, where he was widely recognized for transforming the city’s mental health system, improving its efficiency and changing lives. He invested heavily in empirically supported treatments and worked to implement evidence-based practices. At APA, he would like to continue finding ways to focus on and emphasize the science of the field. “I’d like to reach out to the science community who left APA or have elected not to join because they don’t perceive it as a place for them. I want every psychologist, no matter what they do, to feel like this is the place they should be.” 

And he’s already making sure psychologists’ voices are heard. At the recent round of consolidated meetings in Washington, D.C., Evans encouraged members to speak up about their work, and will continue to do that as he travels around the country and the world on behalf of APA and psychology. “I talked with different groups and asked them, ‘Do people know you’re doing this?’ We need to make sure the public understands it’s coming from APA and our field.”

In a new age of health care, psychologists cannot afford not to be part of the discussion, he says, whether it’s about research funding or prevention. “Right now, our health care system is only set up to deal with people after a diagnosis. There are tremendous opportunities for psychologists in population health to prevent health problems.”

As APA celebrates its 125th anniversary, Evans also wants to make sure the association stays on top of the latest trends in psychology, including emerging technologies, such as mental health apps, artificial intelligence and big data. “We cannot miss an opportunity to be a part of this research. We have to be on the leading edge.”

06 Feb 2017

APA’s Response to Presidential Executive Orders and Statements

APA’s Response to Presidential Executive Orders and Statements

APA is a nonpartisan, scientific and educational organization with a mission to advance psychology as a science and profession and as a means of promoting health, education, and human welfare. When appropriate, APA takes positions on policy issues that are relevant to this mission.

Before adopting any positions or publishing any statements, APA staff, in consultation with association officers, carefully screen the issue to ensure that APA’s engagement is consistent with our mission and association policies, that psychology has something meaningful to contribute to the discussion, and that there is benefit to the organization in getting involved, among other factors considered.

APA has issued public responses to four of the President’s executive orders and public statements. Here are the official executive orders from the White House and a news story regarding a statement by the president, along with APA's responses:

Foreign Entry

Hiring Freeze

'Enhanced' Interrogation

Dakota Access Pipeline

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