More states may soon require psychologists to be trained in equity, diversity, and inclusion

Psychologists are required to complete anywhere from 10 to 25 hours of continuing education (CE) annually to maintain their license, depending on the state (PDF, 55KB)opens in new window. Nine states mandate psychologists to complete a course in equity, diversity, and inclusion (EDI) as part of their CE requirements—but more are pushing for this change.

“There are many potential harms if someone is providing services but doesn’t understand the basics of EDI,” said Raquel Halfond, PhD, senior director of evidence-based practice and health equity at APA. “There are harms of racism, homophobia, and sexism where a psychologist may inadvertently do something harmful. This is particularly important given the increasing diversity of the U.S.”

States like Georgia are advocating for legislation that would add EDI CE to the licensing requirement for psychologists practicing in those states, and APA has assisted in this advocacy.

“EDI should be just as important as diagnosing and ethics training,” said Jason Malousek, PsyD, assistant director of clinical psychology training at Kansas City University in Missouri and past president of the Kansas Psychological Association (KPA). “It should be in writing that your state’s CE training include this type of education.”

Historically, psychology has adopted and perpetuated colonialism and contributed to the systemic and structural barriers faced by people of color (Aiello, M., et al., Journal of Indigenous Research, Vol. 9, 2021opens in new window). Consequently, mainstream psychology is rooted in the perspectives of White people, research led by people of color is often considered to not have enough disciplinary rigor, and factors of race and ethnicity have not been emphasized in peer-reviewed psychology publications.

This Eurocentric perspective is also reflected in the demographics of psychologists in the health service workforce, around 88% of which are White—a number that does not properly reflect the U.S. population. In fact, estimates by the U.S. Census Bureau show that nearly 4 out of every 10 Americans identify with a race or ethnic group other than White.opens in new window From 2010 to 2019, these non-White groups accounted for all the nation’s population growth.

That’s why continued education on EDI is crucial for all psychologists, said Halfond. “Historically, we see a research-to-practice gap of many years. Research will be published, but it will take many years to get disseminated and implemented into psychology practice,” she said. “EDI CE could help close that gap and keep psychologists up to date on new research emerging in this space.”

This research may include a 2020 report by Saint Louis University that defined racism as a public health crisis and reviewed ways in which people and institutions can respond to this issue (Yearby, R., et al., Racism is a Public Health Crisis: Here’s How to Respond, 2020opens in new window). Similarly, another paper offers supportive strategies for schools to develop more inclusive learning environments for lesbian, gay, bisexual, and transgender students (Chan, A., et al., Frontiers in Psychology, Vol. 13, 2022opens in new window).

Clear EDI CE requirements in states would ensure that all practicing psychologists have basic training in this area, said Halfond. Graduate schools, internships, and other educational programs all vary when it comes to what they teach on EDI, if they teach anything related to EDI at all. There needs to be more standardization about what content is covered on a state level, Halfond said.

To change EDI CE requirements, state psychological associations should make sure their board of psychologist examiners—a group of members appointed by the governor that regulates all licensed psychologists within their state—support the proposed legislation.

Doing this successfully requires a thorough knowledge of the state’s political landscape, said Shirley Ann Higuchi, JD, associate chief of professional practice for justice, legal, and state advocacy at APA. “Know the political leanings of your state legislators. You don’t want to ask for something that won’t pass,” Higuchi said.

Also, make sure you get support from your psychology association. That way, you won’t have any opposition on the legislation from your own constituents, Higuchi added.

That is the type of preparation that Abby Brown, PsyD, and her colleagues at the Illinois Psychological Association (IPA) did before submitting their legislation. This bill has since been withdrawn because the Clinical Psychologists Licensing and Disciplinary Board informed IPA that they would like to work with the association to include an EDI CE requirement, as opposed to going through the legislative process. “We will likely begin working with them after the legislative session ends in late May 2023,” said Brown, a clinical psychologist and immediate past-president of the IPA. “The board has assured us that they will work on this with us to make it happen.”

However, Brown still sees the steps IPA took to create a legislative proposal as a great example for other states.

“The team at IPA worked extensively on the proposal to share with the legislators,” Brown said. “We wanted to be as prepared as possible for any questions about why we’re doing this, have the research to back why we’re doing this, and so on.”

Brown also established an EDI task force and created a timeline for the team with everything that needed to be accomplished before the legislative session started in 2023. “We made sure we were getting input and approvals from the proper committees in IPA and confirmed this was something that our association truly was in agreement in pursuing,” she said.

The IPA task force also made sure everyone within the association was aware of all the steps they were taking. “We presented on the process at our annual convention and published the proposal to the newsletter and listserv,” said Brown.

In the proposal, IPA requested three of the total 24 CE hours required in Illinois to be devoted to EDI. They pointed to Illinois census findings indicating that the non-Hispanic White population in the state fell by 14.3% between 2010 and 2020, and the fact that gaps in knowledge by health providers can lead to “misdiagnoses, less effective interventions, diminished or lack of trust in the treatment of the provider, lack of treatment compliance, and premature treatment discontinuation.”

Another part of the proposal was a sample EDI CE program, which included a list of learning objectives that psychologists should complete. “We made a really compelling case for why this is necessary in Illinois,” including meeting the needs of an increasingly diverse population and increasing equitable access to mental health care, said Brown.

A similar proposal was submitted last year by the Georgia Psychological Association (GPA), which asked for six hours of EDI training out of their mandated 40 hours of CE. The organization noted that there is a need for “recurrent learning about social and cultural factors that impact health” and the “ethical imperative to ensure competent, equitable, and non-harmful use of psychological science.”

Luckily, both the IPA and GPA have faced little opposition so far, but efforts in other states are facing stiff resistance. In February, Kansas lawmakers shot down a bill proposed by KPA that would have mandated three hours of EDI CE for psychologists, conflating that type of training with critical race theory. State Senator Mike Thompson (R-Shawnee) said that he didn’t feel EDI CE was an appropriate path, and said that he thought “[psychologists] should stick to their lane. And diversity, equity, and inclusion I don’t believe is helpful at all in this situation.”

Malousek strongly disagrees with this sentiment. “How is EDI not in our lane when we provide services straight to the community?” said Malousek. “EDI is all about how we provide the best possible services to somebody whom we don’t know and need to understand, who has a different life and context. EDI training just makes us better psychologists.”

Higuchi worked closely with KPA on this legislation. “APA’s Ethics Code requires psychologists to be competent, and this legislation adds the cultural competency that enables psychologists to serve more people,” Higuchi said. “It’s ethical to be able to competently provide these services.”

Along with learning about state law and informing psychology associations about proposed legislation, psychologists can take advantage of APA’s many advocacy and EDI resources when trying to change CE requirements.

Since the 1960s, APA has devoted a significant amount of attention and resources to EDI. In June 2018, APA started developing an EDI framework to integrate EDI across the organization and psychology as a discipline. Along with offering states a clear foundation to develop their own EDI curricula, APA has supported states that are working to pass EDI CE legislation.

“Health inequities are not inevitable; they are systemic and avoidable,” says the Report of the 2021 APA Presidential Task Force on Psychology and Health Equity (PDF, 171KB)opens in new window. “At the core of health inequities are structural factors, including social determinants of health that systematically lead to dramatically poorer health outcomes among specific populations.”

APA’s Practice Leadership Conference (PLC) has played a pivotal role in some state psychological association’s legislative proposals. “I attended the virtual PLC last year, and they promoted doing EDI CE in different states,” said Brown. “That’s when we put our heads together and said, ‘Let’s see if this is something we could do in Illinois.’”

PLC also gave members of the KPA an opportunity to spread their wings, said Malousek. “We could talk to different organizations and bring in to form a diversity agenda.”

APA’s 2023 PLC featured a talk on state association management and regulatory issues faced by state, provincial, and territorial psychology associations. One of the meetings discussed state advocacy and included topics such as how to connect with lawmakers and advocacy agendas for 2023 and beyond. Furthermore, APA offered $100,000 in funding for 2022 legislative grants to state psychological associations for defending and advancing the psychology profession.

All these resources are key for psychologists who wish to make legislative change, said Brown. “This was the first legislative process I had ever spearheaded in my life, so I sought a lot of consultation,” she said.

In the upcoming years, Brown said she hopes to see more states take legislative action and push for EDI CE. She said the work done in places like Illinois will serve as inspiration for other psychological associations.

“We should all be working together on this,” Brown said.