Texas leads push for faster certification of mental health professionals

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Aspiring Texas psychologists hope to earn certification and start work faster under a new licensing examination that would be created by the state. The plan, which is catching the eye of other states, calls for Texas boards to conduct state certification tests, eliminating the need for more expensive and time-intensive national certification tests.

This year, the Texas State Board of Examiners of Psychologists moved to begin researching the cost of a cheaper state exam instead of requiring applicants to take a new $450 “skills” test offered by the Association of State and Provincial Psychology Boards.

Sarah Lorenz, a licensed professional counselor in Texas, told the state board last month that Texas is facing a severe shortage of mental health providers and dropping an additional test will not do enough to help.

“We need to fix this provider shortage crisis,” Lorenz said, suggesting that the state might even need to lower the threshold for a passing score to get more people into the profession.

The health care industry overall is facing an issue with licensing as various studies have found the length and expense of certification have adverse consequences.

Psychologist applicants already take a required $800 knowledge exam from the national board. The national board approved the new skills exam in 2016, but it notified states last October that the skills exam would now be required to complete certification by the national body.

This additional skills test was designed to weed out applicants who lacked the skills to work in a clinical setting. However, the licensing board for Texas views this step as unnecessary.

“Show me the unqualified people, this avalanche of unqualified people entering the field, because that is not the case,” said John Bielamowicz, the presiding member of the state psychologists’ licensing board.

Texas is the first licensing board in the nation to consider an alternative to the national exam.

“We would prefer to keep things exactly as they are, but that’s not an option anymore,” said Bielamowicz, adding, “We didn’t have to do this. We don’t want to do this. And there is certainly a downside to it, but we have to do something.”

Currently, Texas licensed psychologists must have a doctoral degree and pass three exams: the $800 knowledge exam by the national testing board, a $210 jurisprudence test, and a $320 oral exam. This is in addition to the $340 a prospective psychologist must pay to do the required 3,500 hours of supervised work. Now the national testing agency wants to add a $450 skills test.

Any failure requires a candidate to retake an exam and pay the price again. A number of mental health providers testified to the board that they have spent thousands of dollars trying to pass the current knowledge exam, and said that adding anything else can be costly.

“Our legislators gave us a directive after Uvalde to reduce or eliminate unnecessary barriers and streamline the process to get more people into the mental health profession,” Bielamowicz said. “Adopting another test is the opposite of this.”

Bielamowicz said the relationship between the state’s licensing board and the national board – ASPPB – has degraded to a point where he can’t see it being mended.

“ASPPB has, with the benefit of hindsight, deliberately and strategically run the clock on us for maximum advantage,” Bielamowicz said. “They turned the screws on us and other states and put us in an impossible position. There has been so much trust broken.”

The Texas Behavioral Health Executive Council this summer sent a letter to the Federal Trade Commission saying the national board has violated federal antitrust laws by updating the Examination for Professional Practice in Psychology to include a second skills test that will go into effect in 2026 without approval and input from the states.

The national board has denied these claims and stated that the allegations against it ignore the long development history and justifications behind the additional test, which is consistent with every other doctoral-level health service licensure examination in the United States and misunderstands antitrust law principles.

The new version of the Examination for Professional Practice in Psychology test “is not a pretextual effort to drive revenue,” the national board said in a statement. “The development of the Part 2-Skills component of the EPPP is the result of a nearly 15-year, member-driven effort to ensure that the EPPP continues to effectively measure entry-level competence through the inclusion of skill-based assessment.”

However, organizations like the Oklahoma Psychological Association are also starting to join the fight against the national board's additional test requirements.

“As advocates for psychology as a science and profession in Oklahoma, we believe the EPPP Part 2 for licensure would serve as a detriment and a deterrent to mental health services,” Joseph James, president of the Oklahoma Psychological Association, said in a statement.

James said the financial burden on trainees and the need for more research on an additional test should make states hesitant to accept this requirement.

“We have spoken with representatives from boards across the country and found that we are not alone in our concerns,” James said.

Bielamowicz confirmed that Oklahoma representatives have contacted Texas colleagues about their effort to create a new test and that he has been encouraged by some of what he has heard from other states about the latest test requirements. He said he plans to discuss their plans at their board meeting on Thursday.

“This issue has really united states that don’t necessarily have similar politics,” Bielamowicz said, mentioning he has heard public comments in New York against the additional test. “There’s a lot of passionate opinions that this is not the right course for a lot of states, not just Texas.”

Chanelle Batiste, a mental health provider in Louisiana and a representative of an equity advocacy group called Radical Psychologists, told the state licensing board last month that they are encouraging other states to take Texas's steps.

“The damage that part two will do to getting a license needs to be discussed,” she said.

Bielamowicz said this potential collaboration between states is crucial.

“While Texas is leading the way,” he said, “Nothing about this effort says this is the Texas test, and it’s ours, and no one can have it. We have had a lot of conversations with state boards and leaders who are running training programs at various universities, who have shown a lot of interest in participating across state lines on what this test would look like and what would be on it.”

Bielamowicz said Texas's creation of its test will come with a series of challenges that need to be addressed, including reciprocity and interstate portability.

“Those are solvable problems, so I’m not afraid of solving them,” he said, “but it certainly introduces some things we’ll have to tackle.”

The price tag for creating a test is also a hurdle, but Bielamowicz is confident lawmakers will provide what is needed if asked. He said he expects to tell lawmakers the situation for the first time during a Senate committee hearing for Health and Human Services.

“It will be legislators' prerogative to tell us to stand down,” he said. “If they don’t think that we should do this, then they’re not going to fund it.”

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