Texas leads effort to speed up certification of mental health professionals

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Aspiring Texas psychologists are hoping to get certified and start working sooner under a new state licensing exam that will be created. The plan, which is attracting attention from other states, calls for Texas boards to administer state certification tests, eliminating the need for more expensive and time-consuming national certification tests.

This year, the Texas State Board of Psychological Examiners began studying the costs of a less expensive state exam instead of requiring applicants to take a new $450 “aptitude” test offered by the Association of State and Provincial Psychological Boards.

Sarah Lorenz, a licensed occupational therapist in Texas, told a state board last month that Texas faces a serious shortage of mental health professionals and that not providing additional testing will not solve the problem.

“We need to solve this provider shortage crisis,” Lorenz said, suggesting the state may even need to lower the pass mark to attract more people to the profession.

The healthcare industry as a whole is grappling with the licensing issue as various studies show that the duration and cost of certification have negative consequences.

Psychology candidates already pass a mandatory $800 knowledge exam from the national board. The national board approved a new skills exam in 2016, but last October notified states that the skills exam would now be required to complete certification by the national board.

This additional skill test was designed to screen out candidates who lacked the skills to work in a clinical setting. However, the Texas licensing board considers this step unnecessary.

“Show me the incompetent people, the flood of incompetent people coming into this market, because that’s not what’s happening,” said John Bielamowicz, chairman of the state’s board of licensing psychologists.

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

“We would have preferred to keep everything exactly as it is, but that’s no longer an option,” Bielamowicz said, adding: “We didn’t have to do that. We don’t want to do that. And it certainly has its downsides, but we have to do something.”

Currently, licensed psychologists in Texas must have a doctorate and pass three exams: an $800 knowledge exam administered by a national examining board, a $210 jurisprudence test and a $320 oral exam. That’s in addition to the $340 that prospective psychologists must pay to complete the required 3,500 hours of supervised work. Now the national examining agency wants to add a $450 skills test.

Each failure requires the candidate to retake the exam and pay the price again. Several mental health providers testified before the committee that they have spent thousands of dollars trying to pass the current knowledge exam and said adding anything else could be expensive.

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

Bielamowicz said relations between the state licensing commission and the national commission – the ASPPB – have deteriorated to the point that he sees no way to repair them.

“The ASPPB, in retrospect, deliberately and strategically used time to gain maximum advantage,” Bielamowicz said. “They tightened the screws on us and other states and put us in an impossible situation. So much trust was broken.”

This summer, the Texas Behavioral Health Executive Council sent a letter to the Federal Trade Commission saying the national board violated federal antitrust laws by updating the psychology professional practice exam with a second skills test that would go into effect in 2026 without consent or consultation with the states.

The national board denied these claims and said the allegations against it disregard the long history of development and justification for the supplemental test, which is consistent with every other doctoral-level licensing exam in the United States and misunderstands the principles of antitrust law.

The new version of the Examination for Professional Practice in Psychology “is not a pretextual effort to raise revenue,” the national board said in a statement. “The development of the Part 2-Skills component of the EPPP is the result of nearly 15 years of effort by members to ensure that the EPPP continues to effectively measure entry-level competencies through the inclusion of a skills-based assessment.”

But organizations like the Oklahoma Psychological Association are also starting to join the fight against additional testing requirements being introduced by the national commission.

“As advocates for psychology as a science and profession in Oklahoma, we believe that the EPPP Part 2 licensing provision would be harmful 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 the additional test should make states hesitant to accept the requirement.

“We spoke to boards across the country and found we were not alone in our concerns,” James said.

Bielamowicz confirmed that Oklahoma officials have reached out to Texas colleagues about their efforts to create a new test and that he has been encouraged by some of the information he has heard from other states about the latest testing requirements. He said he plans to discuss their plans at a board meeting on Thursday.

“This issue really does affect states that don’t necessarily have similar policies,” Bielamowicz said, noting that he has heard public comment in New York against the additional test. “There are a lot of passionate opinions that this is not the right path for a lot of states, not just Texas.”

Chanelle Batiste, a Louisiana mental health professional with the advocacy group Radical Psychologists, told the state licensing board last month that she encourages other states to follow Texas’ lead.

“We need to discuss the damage that the second part will do to the licensing process,” she said.

Bielamowicz said that such potential cooperation between countries is crucial.

“While Texas is a leader,” he said, “there’s nothing in this effort that says this is a Texas test, and it’s ours, and no one can have it. We’ve had a lot of conversations with state boards and leaders who run training programs at different universities who have shown a lot of interest in taking tests from different states, about what that test will look like and what’s going to be on it.”

Bielamowicz said creating a test in Texas will pose a number of challenges that will need to be resolved, including reciprocity and interstate portability.

“These are solvable problems, so I’m not afraid to solve them,” he said, “but they definitely introduce some issues that we’ll have to deal with.”

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 about the situation for the first time during a Senate Health and Human Services Committee hearing.

“It will be the prerogative of legislators to tell us to back off,” he said. “If they don’t think we should do it, they won’t fund it.”

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