New York Association of School Psychologists

Richard Wexler, Ph.D. President New York State Psychological Association

January 22, 2008

Dear Dr. Wexler,

I wanted to thank Drs. Polowczyk and Feder, as well as the rest of the School Psychology Task force, for the time and effort that they committed to studying the issues related to Licensure of Specialist Level School Psychologists. The issues surrounding this legislation and the factors that have led to the current crisis in children’s mental health services in the schools are very complex. While the Task Force has clearly spent time researching some of these issues and factors, the final report to the NYSPA Council contains inaccuracies and omission of facts that directly relate to the conclusions and recommendations.

While NYASP has had a legislative priority of licensure for school psychologists since the “late 1970’s,” the Task Force fails to mention that the current proposal represents a significant modification of past legislation. The definition of the scope of practice that clearly limits professional activity to educational related activities, the addition of specific coursework and training, as well as supervised practice all represent significant departure from the focus of previous bills.

On the surface, the Task Force conclusions and recommendations appear to be viable options to explore. However, an in-depth analysis of the issues uncovers the inadequate and erroneous nature of the findings. The Task Force offers two states, Maryland and Texas, as examples of states where school psychological services are eligible for Medicaid reimbursement because of licensure for “in school practice only.” This statement is

______New York Association of School Psychologists, Inc. P.O. Box 178 Hornell, NY 14843 www.nyasp.org E-mail [email protected] inaccurate and represents a misunderstanding on how Medicaid reimbursement is determined in states. Under broad federal guidelines, each state establishes a state Medicaid plan that outlines eligibility standards, provider requirements, payment methods, and benefit packages tailored to the needs of its citizens. The fact that school psychological services are eligible for Medicaid reimbursement in these two states, as well as the vast majority of states, is determined by the state Medicaid plan, not the credential level of the provider. The following information was sent by the Government and Professional Relations Delegate for the Maryland School Psychology Association. He indicated that “School Psychologists are eligible to bill Medicaid because SCHOOL Psychologists are written into the state plan, with no mention of doctorate or non- doctorate. The Medicaid plan was written in cooperation between MSDE and the DHMH… and they speak to the billing of Medicaid services in the schools by School Psychologists separate from a license to bill outside of the school setting.” The change in credentialing level for school providers in New York determining eligibility for reimbursement resulted from a “settlement” between New York and Federal CMS. As a result of an audit by CMS, New York was found to have significant billing errors. New York was given the option to pay back substantial funds or allow this and other changes to be implemented in their state Medicaid Plan. Therefore, any change in the state’s Medicaid Plan that differs from the Federal position would require the cooperation of New York State. It is highly unlikely that the state would choose to reimburse funds back to the Federal government in lieu of allowing a change to the Medicaid Plan. Even if the Task Force recommendation regarding an “in school practice only” licensure were viable, it fails to meet the new standard of credentialing to “provide services outside the school.” However, it is interesting to note that Maryland and Texas are two of the thirty- one states that allow for some level of practice by sub-doctoral psychologists outside of the schools.

The Task Force recommends the possibility of school-based psychological services provided “under the supervision of a doctoral level licensed psychologist.” It posits that speech language services in the schools are provided in this manner. This recommendation ignores that fact that CMS has already ruled that school psychological services cannot be provided “under the supervision of” a licensed psychologist. Further, this recommendation does not account for the clear fact that the majority of New York State lacks the availability of licensed psychologists. Statistics from the NYSED Office of Professions continues to highlight that the majority of counties in NY have a dearth of licensed psychologists for the community, much less for meeting the demands of the schools.

Finally, the Task Force recommends enlarging “the pool of doctoral level licensed psychologists available within the schools.” Again, this recommendation falls short of the facts. As indicated earlier, the number of licensed psychologists in many areas of the state is inadequate to meet the needs of the schools. Further, there is no “pool” of doctoral level psychologists within the schools. Approximately 25% of New York’s 3600 school psychologists (900 psychologists) are trained at a doctoral level, which leaves 2700 non-doctoral school psychologists. The notion that licensed psychologists could fill the void is frankly untenable, based solely on available numbers. There are currently 9,363 licensed psychologists living in New York State. 74% of these professionals reside within the metropolitan New York City area, accounted for by only 6 of New York’s 62 counties. Of the remaining counties, 25 have 10 or fewer licensed psychologists, and two counties have no licensed psychologists at all. The pool of licensed doctoral psychologists in our state is simply insufficient to serve New York’s 3.3 million schoolchildren. In addition, licensure as a psychologist does not allow for practice within a school setting without further training and mentoring by a school psychologist.

New York is privileged to have 12 APA accredited doctoral programs in school psychology within our state. Yet the need for school psychologists far exceeds the capacity of these programs to produce doctoral professionals at a rate that can meet projected nationwide shortages of school psychologists. Only 5 of the APA-approved programs operate doctoral programs exclusively; the other 7 also offer specialist level programs. Hiring qualified faculty to expand doctoral programs is also a difficult proposition, as positions in school psychology training programs remain vacant each year due to lack of qualified candidates. Further, conversion to doctoral only programs represents significant financial expenditures on the part of these institutions.

The Task Force posits that there would be a “risk to the public” by allowing school psychologist to practice “in the same way as does New York licensed psychologists.” Further, it indicates that most states restrict the practice within public schools only and that the current proposed legislation “expands the scope of practice to activities well beyond what is currently being done within the confines of the schools.” The Task Force offers applying DSM-IV diagnoses as an example. There are numerous inaccuracies in these statements. First, the current scope definition limits the practice of school psychologists to educationally related issues and reflects exactly what schools psychologists engage in on a daily basis. This licensure would not allow the school psychologist to practice “the same way as does licensed psychologists.” There is no expansion of activities. In fact, there is no mention in the current proposal of the use of DSM diagnoses. This is despite the fact that school psychologist currently use DSM diagnoses in classifying children with learning disorders and other behavioral disorders. Finally, the Task Force assertion that most states restrict practice to “schools only” is simply not true. Thirty-one states allow for some level of practice outside the schools by non-doctoral psychologists (see http://www.nasponline.org/certification/state_info_list.aspx for a detailed listing of state credentialing information).

The fear that licensure of school psychologists would result in the “loss of in-school psychological services” due to an exodus of the schools to private practice lacks any basis in logic or fact. Considering the current crisis in private practice, the lack of stability in reimbursement to psychologists, problems with managed care, etc., it is highly unlikely that school psychologists would jump at the opportunity to move into private practice. School psychologists enjoy the security of a regular salary, retirement plans, and, with licensure, greater job security. Further, recent statistic collected by the National Association of School Psychologists actually documents a decrease in the number of doctoral and non-doctoral school psychologist engaging in any private practice. Between 2000 and 2005 the numbers dropped from 4.3% to 4.1% of the school psychologists nation-wide who engage in some level of private practice.

The final three conclusions regarding “public confusion about providers of psychological services,” conflicts between regulatory agencies and “diminution in the quality of school psychological training and services” lack any merit. The public is often confused between a “psychologist” and a “psychiatrist.” However, the generic title of “psychologist” does not provide the specificity to the public of the various subspecialties that are encompassed within this title. One might be a clinical psychologist, consulting psychologist, or counseling psychologist, that engage in different activities. The delineation of SCHOOL psychologist clearly denotes the type of work that these professional engage in. Concern for conflicts between regulatory agencies ignores the fact that other mental health professions (e.g. social work) are regulated by various state agencies. New York appears well suited to cope with this type of regulation. Finally, the data is clear that professionals entering the field of school psychology are not “motivated” to enter doctoral programs to obtain licensure. The standard to practice school psychology has been at the master’s level. Some professionals choose to enter doctoral programs to advance their knowledge, level of training, and potential for expanded scope of practice. Licensure of Specialist Level school psychologists will not prove to be a deterrent to those professionals who choose to expand their practice.

Finally, I wanted to comment on the lack of NYSPA member input that occurred during this process. Although the Task Force consulted with the APA and reviewed “NYSPA’s historical position on licensing,” no input from membership or regional associations was sought. It is apparent from Drs. Perlin and Baker in their “minority report” that further information may have been helpful in formulating NYSPA’s position. Considering the complexity of the issues and impact upon member school psychologists, it is disappointing that the Task Force chose not to seek this information. It also surprises me that NYSPA continues to undermine and denigrate the profession of school psychology. School psychologists serve as an important referral source to psychologists in private practice. There is a growing sense of resentment within the schools of New York against psychologists and the continued position of the state association which impedes the valuable work occurring in the schools.

Again, I appreciate the effort that Dr. Feder and her task force engaged in to explore this issue. However, I would invite NYSPA to become part of the solution to resolve this crisis in children’s mental health services in schools, as well as significant threats to school psychologist’s jobs. This legislation is not about “independent practice” for school psychologists. Since its’ revision last year, the focus of the bill has been on maintaining mental health services for children and ensuring the school psychologist’s role in education. The minimum required credential for the practice of school psychology in many areas of NYS is now licensure. I remain open to further discussions with NYSPA.

Respectfully,

John Kelly, Ph.D. President New York Association of School Psychologists