Certification could help psychologists define their areas of expertise for health-care managers.

By Nathan Seppa
Psychologist Patrick Cerra, EdD, an independent practitioner in Terre Haute, Ind., had never considered getting additional credentials for treating alcohol- and substance-abuse patients-about 20 percent of his caseload.

But when a health-benefits management company started denying coverage for some of his patients earlier this year-saying Cerra lacked credentials to treat them-he decided he needed more than a doctorate and a license to keep his practice thriving.

His timing was fortuitous. In April, 1996 APA's College of Professional Psychology awarded its first batch of certificates of proficiency in treating alcohol and other psychoactive substance-use disorders. Cerra applied, and because he is a licensed health-service provider and met all certification criteria, he promptly became certified. Cerra was one of roughly 700 psychologists whom APA granted certification this spring.

Cerra sent a record of his new credential to the management firm that tried to block reimbursement. A few weeks later, he found himself citing the certificate again, as he filled out forms to maintain his place on another panel whose management firm had been bought out by a larger company unfamiliar with Cerra's work or reputation.

'Thus, the certificate is more than another plaque to hang on the wall,' said Janet Ciuccio, executive administrator of the College.

'This is a way to further define [credentials] for payers, consumers [and] other professionals,' she said. 'It also clarifies a practitioner's areas of expertise-in this case, drug- and alcohol-abuse treatment,' she said.

Like many practitioners, Cerra belongs to panels or networks of providers that handle the mental health-care needs of some large employers, a major source of income.

People who decide which practitioners may serve on such panels need to have the means of gauging the validity of a practitioners' claim to be a specialist in an area of psychology, said Ron Finch, EdD, a consultant in the Health and Welfare Division at Coopers and Lybrand, an accounting and consulting firm in Atlanta.

The people who are building these networks at insurance companies, managed-care companies and coalitions of employers who purchase the services need to see the integrity issue addressed up front, Finch said.

Cerra and other members of the initial certification group will need to pass an examination within the next three years to maintain their certification. Certificates for this group of people who applied before June 1 went only to experienced practitioners who met the requirements. Practitioners applying after June 1, 1996, need to take the examination before getting certified. In general, applicants must:

The three-hour exam consists of 150 multiple-choice questions and can be taken on a computer at more than 200 locations. It will gauge the practitioner's knowledge in such areas as clinical pharmacology and epidemiology of psychoactive substances, causes of substance-use disorders, prevention, screening, diagnosis, treatment, ethical concerns and issues specific to certain populations.

Personnel Decisions Research Institutes of Minneapolis developed the examination, working with psychologists who have expertise in the area, Ciuccio said. Sylvan Technology Centers will administer the tests by appointment. Results are available immediately; applicants get a printout and the results also go to the College for comparison with the passing score. If the applicant fails, a retest can be taken after 90 days. If applicants fail a second test, they must wait a year before being tested again.

'A passing score will be based on knowledge considered necessary for safe, effective practice,' Ciuccio said. 'All of the items are practice related. Sample test questions and a suggested reading materials list will be available. The certificate is designed to make explicit a status already attained,' Ciuccio said.

'Our certification does not begin with the assumption that you now have to become competent,' she said. 'We assume that providers working in the substance-use area are practicing effectively, and we're trying to provide them with an appropriate tool to demonstrate that.'

The substance-abuse certification is a good start, Finch said, but needs to be followed by certifications in other areas.

'Psychology is going to feel some pressure [from benefits companies] to show that they can regulate their own credentialing through the [APA] College, rather than have some credentialing standards placed on them,' he said. 'The College plans to make available more certifications in specific areas, but no decision has been made on the next proficiency to be certified. Members can petition APA to have their area recognized as a proficiency,' Ciuccio said.

'Practitioners need to promote the public's confidence in psychology, and proficiency testing does that,' said Toni Collarini-Schlossberg, PhD, a New York City independent practitioner who was recently certified. 'And while no one relishes taking an exam, she said, tests do set a minimum level and certain standards for knowledge.' Meanwhile, dealing with third-party payers is a reality faced by practitioners, many of whom contract with managed-care providers to work with patients at set fees, she said.

'You have to demonstrate some specialty or proficiency in order to gain access to more than one client population,' she said. 'Not knowing where managed care is going [in the future], you have to be somewhat aggressive in your career goals. I see myself practicing another 20 years.'

The certification may also work as a marketing tool. Cerra plans to include it in his entry in the local Yellow Pages this summer.

'This credential meets the high standard for integrity in the world of professional credentialing,' Ciuccio said. 'Hopefully it will be regarded as such by everybody, not just payers.' The certificates will need to be renewed every three years. For post-June 1 applicants, the initial fee will be $325 for APA members and $395 for nonmembers, plus a $200 examination fee, paid at the time of testing.

Thereafter, a $50 annual maintenance fee will be charged, plus a renewal fee of $125 every three years. The recertification program also requires practitioners to obtain 18 hours of continuing-education credit during the three-year certification period.

To obtain more information or to request application materials contact:

College of Professional Psychology
APA Practice Organization
750 First Street, NE
Washington, DC 20002-4242