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A costly new national certification exam for psychologists has convinced the profession’s licensing authority in Texas to consider crafting a cheaper alternative to help alleviate a persistent mental health provider shortage here.
On Thursday, 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, known also as ASPPB.
Applicants already take a required $800 knowledge exam from the national board. The new skills exam was approved by the national board in 2016 but it notified states last October that it would now be required to complete certification by the national body.
Refusing to adopt this additional test would mean psychologists in Texas would be ineligible to use the existing exam, something the state licensing board has used to license psychologists here since 1965.
“Let's call a spade a spade. This is a negotiation tactic. It was a deadline that was long enough in their minds to have agencies swallow this bitter pill, but not adequate time to craft a good solution to it,” John Bielamowicz, the presiding member of the state psychologists’ licensing board, said Thursday.
Texas is the first licensing board in the nation to consider an alternative to the national exam. But the state board said it would back off its gambit if the national testing board considered making the new exam optional instead of required.
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 an addition to the $340 a prospective psychologist must pay to do their required 3,500 hours of supervised work and now the national testing agency wants to add a $450 skills test on top of it.
Any failure of these tests requires a candidate to retake the exam and pay the same price. Multiple mental health providers testified to the board that they have spent thousands of dollars trying to pass the current knowledge exam, and adding anything else can be costly.
“I spent close to $9,000 trying to pass the first (knowledge test),” said Sarah Lorenz, a mental health counselor in Dallas. “If the board feels held hostage to an authoritative mandate, imagine how we feel. Focus on our state—Texas only.”
The Texas psychologists board is mindful of the fact that there is a critical shortage of mental health providers in this state. Some board members like Jamie Becker, saw this new requirement as one more barrier to getting providers licensed and into the workforce quickly.
“I don’t think this test is horrible nor do I think what you are asking of us is terrible, but this will impact a lot of providers we need. We have providers who practice in rural areas. People who come from different backgrounds and languages, and this is just making it harder for them to become licensed because of the cost,” Becker said. “I am trying to find a reason to justify, and I am struggling with it.”
Today, 251 of Texas’ 254 counties are wholly or partially designated by the federal government as “mental health professional shortage areas,” and that’s in a state where roughly 5 million people do not have health insurance.
Therapists, counselors, and psychologists are often interchangeable terms the public uses to describe a mental health provider. However, the pathways to these careers are very different. Counselors focus on specific issues that affect mental well-being instead of outright illness, and it only requires a license and a bachelor's degree depending on the specialty. A therapist must have a master’s degree in psychology to practice.
This additional skills test was designed to weed out applicants who might have barely passed the knowledge exam but lack the skills to work in a clinical setting.
“We are the only health providers without a skills exam,” Michelle Paul, president of ASPPB, told the board. “This is a problem because we want psychologists to sit side by side with other health providers, but we don’t have the same standards.”
Paul told The Texas Tribune this new test is needed in a post-COVID-19 pandemic world where students had to learn under unusual circumstances.
“We need providers everywhere, not just in Texas. That said, we need competent providers. We shouldn’t let the idea of barriers disintegrate the value of psychology,” she said.
However, the licensing board in Texas believes this is an unnecessary step since they have not heard any complaints about ethics or preparedness from mental health providers.
“This is a solution looking for a problem that also doubles the expense of test takers,” said board member Ryan Bridges.
So far, only Georgia, Nevada and Washington, D.C. have adopted this new skills test.
As the need for more mental health workers grows, Texas lawmakers and regulatory agencies are looking more closely at job requirements and ways to get more people licensed quickly to help bolster the mental health workforce. More families are opting to bypass waiting lists and heading straight to emergency rooms with loved ones who need treatment for example.
At Thursday's meeting, board members also raised concerns about whether the new test accurately measures clinical skills and whether it creates more barriers to entry for applicants, particularly people of color or those who speak a different language.
More than 50% of Texas residents are Hispanic, but the mental health provider population is overwhelmingly white, according to 2023 data. Also, less than 20% of the state’s 10,440 mental health providers that responded to that 2023 workforce survey offer mental health services in a language other than English.
Representatives for the national testing board insist their tests are designed to protect the public.
Paul, the president of the Association of State and Provincial Psychology Boards, also said the mental health workforce issue will not get solved at the licensure level.
“How many doctorates are graduating in psychology? Maybe eight to 10 a year. We need to invest in training programs for more students. That is how you solve this problem,” she told the Texas Tribune.
Paul is hopeful a solution can be found between her agency and the state of Texas. Board members indicated that if Paul’s group would make the skills test optional, it would consider abandoning its pursuit of a homegrown Texas test.
“We are open to conversations about this exam. I hope the relationship is not too fractured and broken,” she said.
However, to some in the board’s meeting room, the new requirements seemed like an ultimatum.
Gloria Canseco, the presiding member of the Texas Behavioral Health Executive Council, put it more succinctly while testifying in support of the psychologist board’s action.
“Don’t mess with Texas. It looks like something you might see on a bumper sticker, but that is our state persona. We push back, and I suggest we push back here,” she said.
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