Texas Leads Fight for Faster Certification of Mental Health Professionals

Sign up for The Brief, The Texas Tribune’s daily newsletter that keeps readers up-to-date on the most important news from Texas.

Aspiring psychologists in Texas hope to earn certification and enter the workforce more quickly under a new licensing exam that would be created by the state. The plan, which has attracted 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 Examiners of Psychologists began investigating the cost of a cheaper state exam, rather than requiring candidates 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 faces a severe shortage of mental health providers and that eliminating one more test will not be enough to improve the situation.

“We have to solve this provider shortage crisis,” Lorenz said, suggesting the state may even have to lower the threshold for a passing grade to get more people into the profession.

The health care sector as a whole is struggling with a licensing problem. Several studies have shown that the length and cost of certification have negative consequences.

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

This additional skills test was intended to screen out candidates who did not have the skills to work in a clinical setting. However, the Texas Licensing Board considers this step 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 Board of Psychologist Licensing.

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

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

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

Each time a candidate fails, they must retake an exam and pay the price again. A number of mental health providers testified to the board that they spent thousands of dollars trying to pass the Current Knowledge exam, and said adding something else could 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 mental health care,” Bielamowicz said. “Putting in another test is the opposite of that.”

According to Bielamowicz, the relationship between the state licensing authority and the national agency – ASPPB – has deteriorated to such an extent that he does not expect it to be restored.

“ASPPB, with the knowledge we have now, deliberately and strategically ran the clock on us for maximum advantage,” Bielamowicz said. “They put the screws on us and other states and put us in an impossible position. So much trust has been broken.”

The Texas Behavioral Health Executive Council sent a letter to the Federal Trade Commission this summer, saying the national council violated federal antimonopoly laws by updating the Psychology Professional Practice Examination to add a second proficiency test, set to take effect in 2026, without state approval and input.

The National Board has denied these claims, stating that the allegations against it ignore the long history of development and justifications behind the additional test, which is consistent with every other doctoral examination for health care licensure in the United States and misunderstands the principles of competition law.

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

However, organizations such as the Oklahoma Psychological Association are also beginning to join the fight against the national board’s additional testing requirements.

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

According to James, the financial burden on trainees and the need for more research into an additional test could make states reluctant to accept this requirement.

“We spoke to board representatives across the country and found that we are not the only ones with concerns,” James said.

Bielamowicz confirmed that Oklahoma representatives have reached out to Texas counterparts about their effort to create a new test and that he is encouraged by what he has heard from other states about the latest testing requirements. He said he plans to discuss their plans at their board meeting on Thursday.

“This is a real problem for the United States, which doesn’t necessarily have a similar policy,” said Bielamowicz, who said he has heard public comments in New York opposing the additional testing. “There are a lot of passionate opinions that this is not the right direction for many states, not just Texas.”

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

“The harm that Part Two will do to licensing needs to be discussed,” she said.

According to Bielamowicz, this potential cooperation between states is crucial.

“While Texas is leading the way,” he said, “there’s nothing in this effort that says this is the Texas test, and it’s ours, and nobody else can have it. We’ve had a lot of conversations with state boards and leaders who run training programs at various universities, who have expressed a lot of interest in participating across state lines in what this test would look like and what it would include.”

According to Bielamowicz, the development of the test in Texas presents a number of challenges that need to be addressed, including reciprocity and portability between states.

“Those are solvable problems, so I’m not afraid to solve them,” he said, “but it certainly introduces some issues that we’re going to have to address.”

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

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

The Texas Tribune’s signature event of the year, the Texas Tribune Festival, brings Texans closer to politics, policy, and the news of the day from Texas and beyond. On September 7, we wrapped up our 2024 Festival — three unforgettable days filled with 100+ sessions and events.

Watch on-demand recordings and read the most important headlines from festival events on the Tribune’s festival news page.