Chapter X. Professional Affairs (Part 1)
Psychologists in public programs, whether engaged in service or research, typically seek to work cooperatively with members of other professions with special competencies which they as psychologists do not possess. Such collaboration is most effective when the members of each profession have respect for the special competencies, skills, and responsibilities of each of the other professions represented on the team. Effective collaboration is impeded whenever one profession assumes a hierarchical domination of another or treats another profession as ancillary.
The American Psychological Association believes that psychologists can make their greatest contribution to public service programs only if the administrative structure of the organization enables them to assume full responsibility for their professional activities. By virtue of the standards of selection, professional education and ethical conduct accepted by this association, psychologists are qualified to assume full responsibility for their procedures, techniques, decisions, and actions as psychologists.
Psychology as an independent science and profession
Council reaffirmed the concept that psychology is an independent science and profession and that in his/her work the psychologist and his/her client independently determine the proper application of his/her work in whatever context he/she may be functioning.
Where psychotherapy, psychoanalysis, or other forms of psychological treatment or behavior modification are undertaken as a required or credited part of the professional preparation of a psychologist, the cost of such training should not be charged against a health plan by either the trainee or a psychologist/therapist, but where a psychologist or trainee may have a recognized mental disorder and seek professional assistance, the therapy should not be claimed as professional training and should be a reimbursable expense within the limits of the individual's health plan.
Application of hypnosis
Be it resolved that the American Psychological Association, in the interest of the public, opposes applications of hypnosis by persons who are not fully trained members or advanced students of health delivery professions and who lack specific, in-depth training in hypnosis. Therefore, be it also resolved that APA opposes the teaching of hypnotic induction techniques or applications of hypnosis that involve treatment or assessment with patients or clients to persons who are not fully trained members or advanced students of a health delivery profession.
Use of “Dr.”
That the APA adopt as the standard that it will recommend to the media for the use of 'Dr.' the following: Doctor should be used in references to all individuals who hold doctoral degrees -- MD, PhD, or other --- in any context or format where the title 'doctor' is used for any of them.
Collaboration with professional nursing
Council voted to affirm that it is APA policy to work collaboratively with the elected leadership of professional nursing in areas of mutual concern and interest.
General guidelines for providers of psychological services
Council voted to approve as APA policy the revision of the 1977 Standards for Providers of Psychological Services renamed General Guidelines for Providers of Psychological Services (PDF, 712KB).
Managed healthcare programs
WHEREAS, many mental health problems are reflective of profound problems of living, substantial intra-psychic disorganization or serve physical and psychological disruption; and
WHEREAS, some psychological services are specifically focused on the alleviation of the personal distress attendant thereto; and
WHEREAS, managed care or other health care delivery systems should not unduly discriminate against those consumers who need intensive care, against those who need specialty care, and should not systematically endorse short-term or biomedical intervention as the treatment of choice for all patients at the expense of individual needs; and
WHEREAS, managed care delivery programs, by their very nature, frequently impose artificial and/or economic barriers to consumer access to health care services and, as such, are as subject to mismanagement as are traditional funding and delivery systems; and
WHEREAS, many managed health care programs may unfairly exclude those with the greatest need from adequate care and/or otherwise put both consumer and participating professional at substantial economic/psychological risk; and
WHEREAS, it is important that mental health care delivery programs provide appropriate and equally high quality services to all persons in diverse client and underserved populations; and
WHEREAS, providers and patients should be informed of the limitations and restrictions to types and access of psychological services prior to subscribing to a plan (i.e., truth in advertising or explicit statements regarding any financial disincentives to treat and refer patients in need of psychological services),
THEREFORE, BE IT RESOLVED that the American Psychological Association urges consumers, subscribers and psychologists to review carefully the mechanisms, procedures, practices and policies of managed care programs before deciding to participate. Although such programs may offer the potential to expand access to appropriate mental health care, they may also restrict availability of necessary psychological services.
It is further recommended that providers may wish to require as a condition of their participation that such managed health care delivery systems adequately and concretely demonstrate provisions to serve the consumer's interest with sufficient quantity and highest quality of health care based on the available scientific evidence of efficacy.
It is further recommended that consumers, subscribers and psychologists, as a condition of their participation, require that these programs practice truth in advertising regarding the range and duration of psychological services available through the plan and that these programs provide patients access to a diversity of psychological health care competencies based on the available scientific evidence of efficacy.
It is also recommended that providers require that such systems operate in accordance with prevailing standards of care and prevailing scientific knowledge, applicable ethical principles, and that the systems have sufficient economic resources to cover the delivery system's liabilities.
Finally, individual members, state psychological associations and divisions are strongly urged to monitor and inform themselves of the legal and regulatory requirements imposed on managed health care systems and to advocate that such requirements meet the principles enumerated herein.
For almost half a century, psychology has been guided by its own self-developed principles of ethical behavior which are intended to protect uses of psychological knowledge and services. Impairments in the performance of psychologists, induced by mental health problems, substance addiction, and other disturbances, lead to violations of APA's purposes and ethical principles. Prevention programs and early interventions may reduce the incidence and the intensity of impairment. Such actions may best be introduced on the state level. Based on these premises, APA resolves:
to provide information and assistance regarding problems of impaired psychologists to State and Provincial Boards of Examiners, the American Association of State Psychology Boards, and State Psychological Associations;
to provide informational liaison services to the states through its Board of Professional Affairs;
to encourage the APA and Division program committees to give due consideration to impairment in choosing topics;
to advise the editors of the APA Monitor and state and division newsletters of the importance of the educational role in countering impairment;
to facilitate public information programs through the APA Public Information Office. This will include, but not be limited to, developing a directory of impaired psychologists programs; and
to review periodically, psychology's progress in confronting impairment.
Resolution on licensing for psychoanalysts
On the recommendation of the Board of Directors and the Board of Professional Affairs, Council voted to approve the following resolution on licensing for psychoanalysts: [The text of the second paragraph of the resolution reflects amendments approved by Council in February 1992.]
"APA has long endorsed the principle of generic education and training for psychology, further recognizing that within any profession there are identifiable and demonstrable specialties.
Thus, from the standpoint of these principles, psychoanalysis is viewed as a set of theories and techniques. In addition, psychoanalysis is viewed as an advanced specialization of a number of professions rather than as an independent profession. Therefore, APA does not recognize psychoanalysis as an independent or licensable profession.
Guidelines on hospital privileges: Credentialing and bylaws
APA statement on alcohol and other drug abuse
APA Statement on Alcohol and Other Drug Abuse (PDF, 34KB)
Removal of licensure exemptions for psychologists in public health care programs
Council takes full note of the difficulties each state jurisdiction faces in implementing any proposed changes in statutes governing the practice of psychology. It also recognizes that there are unique circumstances that help shape the practice of psychology in the various states. Nonetheless, and in the hopes of stating more clearly the Association's aspirations for the field's future evolution, it adopts the following resolution:
WHEREAS many states have licensing laws that exempt psychologists from licensure if they provide health care services to clients within state or public agencies, programs and institutions, and
WHEREAS these exemptions in fact or in appearance imply that minimal requirements for competence as indicated by licensure in the profession are not needed when providing health care services to clients within public programs, and
WHEREAS the existence of these exemptions provides a double standard for the care of individuals receiving psychological health care services in public programs, many of whom are poor, of minority backgrounds, and without health insurance or adequate health insurance,
THEREFORE be it resolved The APA adopts and promotes policy -
a) to remove state licensure exemptions for psychologists providing healthcare services to clients of state or public agencies, programs and institutions.
b) to exempt psychologists from licensure who are already employed in public programs at the time of enactment of these proposed changes in licensing laws.
c) to require licensure or the obtaining of licensure within three years of appointment for psychologists as a condition of employment when providing health care services in such programs and to require appropriate supervision of the health care services provided by unlicensed psychologists during this initial period of employment.
d) to require licensure of school psychologists unless their practice is limited to a school setting and is regulated or certified by an appropriate state education agency, and
e) to develop position statements on licensure exemption issues that are consistent with this resolution and the APA's Model Licensing Law, to work with state psychological associations to amend state licensing laws during sunset review cycles to remove exemptions covered by this resolution, and to begin working immediately with federal and state agencies to remove regulations exempting psychologists from licensure or add regulations that require licensure when psychologists are providing health care services to clients within state or public agencies, programs, and institutions.
It is further resolved that APA work with state licensing boards and groups such as the National Association of State Mental Health Program Directors and the National Association of Community Mental Health Centers to develop strategies to minimize the impact of implementation of this resolution on underserved populations and to incorporate appropriate exemptions or examinations for those psychologists uniquely qualified to serve divergent and underserved populations.
APA position statement on managed care (MC) and utilization review (UR)
WHEREAS Government officialdom, representatives of industry and employer groups, and representatives of managed care (MC) and utilization review (UR) companies are increasingly and aggressively promoting managed care as a solution to the nation's health care delivery problem;
AND WHEREAS objective data as to the efficacy of MC and UR approaches to the nation's health problems when adequate quantity and high quality of care are held constant is not extant;
AND WHEREAS degradation in the quantity and quality of care occasions rising concern;
AND WHEREAS the media and the courts (see New Republic, "Managed Care: A Sick Joke"; American Psychiatric News, December 20, 1992; New York Times, "Do They Want My Wife to Die?," April 15, 1992) have documented flagrant abuses by some MC and UR companies;
AND WHEREAS both administration and congressional proposals for health care reform, almost without exception, mandate the establishment of national MC and UR programs exempt from all state mandates as to benefit structure and regulation of service provisions and state controls as to the standards of care;
THEREFORE BE IT RESOLVED The American Psychological Association calls upon the Congress and/or the President to develop objective data demonstrating that managed care and utilization review can effect economic savings while maintaining acceptable levels of quantity and quality care BEFORE committing to such programs as a solution to current problems in health care delivery.
The American Psychological Association believes that the exemption of any MC or UR program from state-mandated benefits and/or state-mandated controls is demonstrably contrary to the public interest unless such mandates and/or controls are replaced by federal controls and mandates offering the same or greater protection.
The American Psychological Association believes that all managed care and utilization review programs should be held to the same high standards of performance required of credentialed providers in the states in which MC and UR services are offered; and the APA urges its state affiliates to become involved in a legislative process designed to procure such regulation. In legislation of this type, professionals' responsibility to protect the public interest demands the involvement of all health disciplines. The Council of Representatives of the American Psychological Association requests that the affiliated state psychological associations:
take a leadership role in developing the legislative process and content; and
also take a leadership role in developing effective coalitions of health disciplines to address the increasingly serious problems in order to protect the public interest.
The American Psychological Association further asks the Congress and the Administration to develop minimum standards for federally sponsored national MC and UR programs as the most efficacious way to avoid the numerous problems currently affecting the quantity and quality of care that have developed under Medicare. Hopefully, such action at a federal level will also help diminish the spate of litigation which we believe MC and UR programs have already begun to engender.
Comprehensive and coordinated psychological services for childen: A call for service integration
Supervisors for psychological services in schools
Supervisors for Psychological Services in Schools Psychologists working in school settings are often concerned about the frequent practice of being supervised by a nonpsychologist. Such nonpsychologist supervisors are often not familiar with the ethical responsibilities and professional standards that guide the practice of psychology. Without a common frame of reference, conflicts between what the profession expects or demands and what a nonpsychologist supervisor requires are likely to occur.
The American Psychological Association/National Association of School Psychologists Interorganizational Committee (APA/NASP IOC) has reviewed the issues and concerns associated with the supervision of psychological services in schools. The APA/NASP IOC developed the following policy guidelines dealing with supervision of psychological services in schools in order to provide guidance to school administrators and individual providers of school psychological services on the appropriate types of supervisors and supervisory responsibilities.
It is recognized that school psychologists who are certified by their state education agency are permitted to use the term school psychologist or certified school psychologist as long as they are practicing in the public schools (APA Model Act for State Licensure of Psychologists, July 1987). Employing agencies assure that an effective program of supervision and evaluation of school psychological services exists for the benefit of all students (NASP Standards for the Provision of School Psychological Services, 1984).
In context, supervision is focused on the professional psychological services and functions performed by school psychologists. At the same time, it is acknowledged that school psychologists may be administratively accountable to other school district administrators such as directors of student services (APA General Guidelines for Providers of Psychological Services, 1987).
To this end, the APA/NASP IOC believes that guidelines such as the following should be used when addressing the issue of professional supervision, at state or district levels, for school psychologists practicing in the schools:
School psychologists' professional psychological functions in schools should be supervised by qualified supervisory school psychologists.
A supervisor of school psychologists should meet appropriate criteria such as (a) certified by the State Board of Education on the basis of having completed a program for the preparation of school psychologists that is accredited by a specialized professional accrediting body recognized by the Commission on Recognition of Post-Secondary Accreditation (APA Model Act for State Licensure of Psychologists, July 1987); (b) who has completed three years of successful, documented, supervised experience as a school psychologist; and (c) who has been designated by an employing agency as a supervisor responsible for school psychological services in the agency (NASP Standards for the Provision of School Psychological Services, 1984).
Veterans Affairs (VA) psychology
WHEREAS the Department of Veterans Affairs has a long-standing commitment and history of providing health care to the veterans that have served this country;
WHEREAS VA psychologists have provided a critical service and leadership role in the health care, training, and research mission of the Department of Veterans Affairs; and
WHEREAS health care reform discussions must support the continued role of VA psychologists in serving our nations' veterans;
BE IT RESOLVED that APA establish a high priority to support the continued service to veterans by VA psychologists by (a) presenting the importance of VA psychology's role in veterans' care to the Administration and congressional leaders and policymakers and (b) by opposing attempts to reduce the level of employment of VA psychologists.
Resolution concerning "Mental Health Consumer Protection Acts"
WHEREAS a major purpose of the American Psychological Association is to advance psychology as a science and profession as a means of promoting human welfare; and
WHEREAS for almost 50 years the ethical standards of the American Psychological Association have provided extensive safeguards for consumers of mental health services; and
WHEREAS those same standards have been incorporated into state law and regulation to provide additional statutory protection for the consumer; and
WHEREAS these same standards require psychologists to practice only within the boundaries of their competence as determined by demonstrable education, training, and experience; and
WHEREAS there are current efforts to introduce bills in the form of "mental health consumer protection acts" such as those currently being considered by the New Hampshire and Illinois legislatures which purport to protect consumers but on closer inspection contain many provisions that will actually harm consumers and curtail availability of quality services;
NOW THEREFORE the American Psychological Association is opposed to the enactment of legislation that, while seeming to protect the consumer, actually creates a bureaucracy and unnecessary barriers that interfere with consumer access to mental health services and fails to protect consumers.
Resolution on prescription privileges for psychologists
The Council of Representatives reaffirms as policy its 1986 acceptance of the following resolution: The practice of psychology encompasses the observation, assessment, or the alteration of behavior and/or concomitant physiological functioning through behavioral procedures. The techniques available to effect such alterations include both physical as well as purely psychological interventions applied by psychologists operating within the limits of individual training and experience.
In taking this action, the Council specifically notes that the practice of psychology includes the use of physical as well as psychological interventions when such interventions are (a) in the consumer's interest and (b) within the training, experience, and competence of the attending psychologist. Specifically, this current action contemplates and supports Association activities in seeking prescriptive privileges for psychologists. Such activities may include, but are not limited to, support and assistance for the development of appropriate training curricula and training programs, support and assistance for legislative advocacy, etc.
Council directs the Committee for the Advancement of Professional Practice, the Board of Scientific Affairs, and the Board of Educational Affairs to develop curriculum (beyond the professional psychology core) and model legislation to implement the process of preparing psychologists to prescribe.
Strategies to promote increased public understanding of the independent practice of psychology
The Association will expand and increase its activities, primarily in the Practice Directorate, but additionally wherever relevant and appropriate within Central Office to: (a) collaborate with and assist state psychological associations in their efforts to protect and enhance the practice of psychology by fully qualified providers, (b) assist states in modifying licensing laws that are inconsistent with APA policy regarding psychological practice and the qualifications of providers, and (c) support state associations in statutorily defining the title "psychologist" to mean those qualified providers with the doctoral degree, and (d) facilitate public protection by opposing legislation which permits the independent practice of psychology by unqualified providers.
The CEO will direct the development of a plan for a national educational campaign to increase public awareness about psychologists, psychological practice and the value of psychological services, education, training and research in the new health care environment.
Guidelines for engaging in the contractual provision of psychological services in schools
Given the economic recession of the past decade, school districts have sought less expensive approaches to providing psychological services to students in schools. One option frequently explored is the replacement of full time school psychologists employed by the district with psychological services provided by psychologists on a contractual basis. Such contractual services are often part time and sometimes restricted to only those services the district is legally required to provide.
While part time or full time contractual services provided by competent psychologists are reasonable alternatives, such contractual services do raise potential problems. One concern is the appropriate credential that should be obtained by a contractual provider of psychological services to schools.
The APA Model Act for State Licensure of Psychologists (APA, 1987) and most state licensing laws exempt from licensure those individuals who are credentialed as school psychologists by a state department of education and are "employed" by the schools. As contractual service provision has become more common, the question has been raised by both individuals and various state boards of psychology and education as to whether an individual can be hired to provide school psychological services on a contractual basis without a license from a board of psychology. One interpretation has been advanced that contractual services, whether full or part time, still constitute employment by the schools and thus no license is necessary beyond a department of education credential. The alternative interpretation holds that contractual services, whether full or part time, constitute the independent (i.e., autonomous) provision of services. Under the latter interpretation, the individual does not meet the criteria of employment and thus should not be exempted from licensure.
A second concern related to contractual services in school psychology deals with the potential for psychologists to lose their professional autonomy and be hired to perform specific functions rather than function as a professional who delivers comprehensive services. A clear example is a situation where a psychologist is hired to conduct assessments for special education placement where the assessment procedures and parameters are dictated by the contract with no opportunity to alter the process, if necessary. Further, such narrowly prescribed service contracts may impede the provision of comprehensive and integrated services.
The American Psychological Association/National Association of School Psychologists Interorganizational Committee (APA/NASP IOC) has reviewed the issues and concerns associated with the provision of psychological services on a contractual basis. The APA/NASP IOC developed the following policy guidelines dealing with contractual services in school psychology in order to provide guidance to state boards of education and psychology, school administrators, and individual providers of school psychological services on the appropriate credentialing and use of contractual service providers.
Contractual Psychological Services by School Psychologists In Schools
Recognizing that there are school psychologists who provide services to school districts on a part-time basis, and in order to ensure professionalism in services, the APANASP IOC recommends the following as a way to identify those school psychologists who function as employees of a school district. Other psychologists who are not employees are considered to be independent service providers under contract to a school district and therefore must be licensed by a state psychology regulatory board. In doing so, the APAMASP IOC:
recognizes that school districts employ state education agency credentialed school psychologists and that employment should be defined to include part time employment.
reaffirms the need for school systems to employ school psychologists, whether employed full or part time, to deliver a comprehensive range of services.
emphasizes that these public policy recommendations are meant to include, not exclude, existing school psychological personnel.
Within the bounds of state law and statute, any contract for services by a school psychologist with most of the following conditions should constitute employee status of a school psychologist by a school system:
a) that the person providing the agreed upon services is a school psychologist who is certified by the state board of education on the basis of having completed a program for the preparation of school psychologists that is accredited by a specialized professional accrediting body recognized by the Commission on Recognition of Post Secondary Accreditation.
b) that the work is done in the context of an employer employee relationship (e.g., the work is to be performed on school board property, using school board supplies, and under school board supervision).
c) that the contract is such that the school district takes legal responsibility for the work¬-related conduct of the school psychologist.
d) that the school system directly pays the school psychologist for all services rendered.
e) that the agreed upon school psychological services are provided in the context of a comprehensive service delivery system and are not limited to any specific type of service and include opportunities for follow up and continuing consultation.
f) that the school psychologist is given appropriate access and information to provide the agreed upon services, and that he or she is familiar with the instructional resources of the employing district such that any recipients of such services have the same opportunities as those served by a full time school psychologist.
g) that the agreed upon school psychological services are provided in a manner consistent with recognized ethical and professional standards, including appropriate supervision.
These guidelines have no binding effect and do not impose any limitations on the contracting activities of psychologists or school authorities. Decisions in this area are the responsibility of the appropriate educational and licensing authorities.
Recognition of health service providers
Psychologists are recognized as Health Service Providers if they are duly trained and experienced in the delivery of preventive, assessment, diagnostic and therapeutic intervention services relative to the psychological and physical health of consumers based on: 1) having completed scientific and professional training resulting in a doctoral degree in psychology; 2) having completed an internship and supervised experience in health care settings; and 3) having been licensed as psychologists at the independent practice level.
Managed care accessibility and reimbursement critera
APA commends those managed care organizations (MCOs) which publish the criteria they use to determine accessibility to, and reimbursement of psychological and neuropsychological services. APA recognizes these MCOs for their responsibility and commitment to publicize their critical decision-making rules.
Correspondingly, APA strongly objects to the practice of any organization that makes healthcare accessibility or reimbursement decisions without publishing the criteria upon which these decisions are based. It is the position of APA that such decision-making criteria should be made accessible so that these critical variables may be subjected to scientific, professional and public review and scrutiny.
Furthermore, it is the position of APA that all MCOs should publish not only their decision-making criteria, but also the process by which these criteria have been developed and applied. To implement the above policy Council requests that the Practice Directorate, on behalf of APA, solicit the MCOs for the release of their criteria and decision-making process.
Follow-up to the "Principles for the Provision of Mental Health & Substance Abuse Treatment Services: A Bill of Rights"
WHEREAS APA has adopted the Principles for the Provision of Mental Health & Substance Abuse Treatment Services: A Bill of Rights and it has come to Council's attention that the procedures and policies of some managed care companies may violate these rights...
THEREFORE be it resolved that APA is committed to identifying and publicizing any abuses by those managed care companies which violate patients’ rights as well as policies that uphold these rights and to educate consumers about their rights as patients.
Disaster Response Network
Council voted to approve designating the Committee for the Advancement of Professional Practice as the appropriate governance entity with responsibility for the Disaster Response Network administered by the Practice Directorate.