Before the Indiana Board of Psychology
Regarding the Restricted Test List Rule
On Behalf of the
January 23, 2004
I am J. Scott Hinkle, the Clinical Training Administrator for the National Board for Certified Counselors (NBCC). I am thankful for the opportunity to address the Indiana Psychology Board regarding the proposed rule to restrict the administration and interpretation of specifically identified psychological tests, specifically to not include duly trained counselors in Indiana.
I begin with a review of my background. I am a Licensed Psychologist in North Carolina, receiving my Ph. D. from Florida State University and my Master’s in pre-clinical psychology at Ball State University in Muncie, Indiana. I was a full-time graduate professor for 13 years where I taught the masters’ assessment class and the advanced doctoral course in clinical assessment. I currently work at the National Board for Certified Counselors where I have tasks that range from clinical tape reviews for national certification to teaching graduate courses in psychodiagnosis. I have maintained a private practice now for over 20 years, and I use psychological tests.
The National Board for Certified Counselors respectfully opposes the proposed rule and after thorough review, finds the rule to be about professional turf issues and market share and not about protecting the citizens of Indiana. NBCC’s opposition is based on the fact that clinical competency is not, and should not, be based on professional membership or identity. Furthermore, our understanding of the proposed restrictive ruling is that nonpsychologists will be denied the use of tests on a specified list, unless one is a priest or rabbi or lawyer or psychiatrist. We suggest that all licensed mental health professionals also be exempted from this rule. The outright denial of the use of tests puts the culpability of regulation on exactly that – denial. When, in fact, it should be placed on two mitigating factors, namely training and experience. Training and experience makes one competent. Not allowing testing, no matter how much the proposed list is shortened, lacks attention to the mitigating factors of training and education.
After thorough review of the tests on the restricted list, we have two major issues to bring to your attention, as well as several lesser issues. First, the list is exhaustingly long, some tests are dated or rarely used, and it is unknown as to how these tests were selected for restriction. Secondly, the list has been modified from 317 to 237 tests. NBCC has asked for an explanation for this reduction and none has been provided. We do not know if the original list was scientifically selected. For example, what were the inclusion rules? To be more specific, why is the ADHD Symptoms Checklist on the restricted list? This instrument, as are numerous other instruments, is a checklist and has demonstrated prior and effective use by other nonpsychology professions, including teaching. Furthermore, we do not know what the exclusion rules were for the reduction of the list. NBCC publicly and categorically challenges you to share your method for establishing this list for several reasons, namely:
Further, NBCC challenges the Psychology Board to answer our challenges to each of the tests on the first and second lists.
The proposed rule, the controversy it has generated, the opposition it has created, and its illumination of the Board’s lack of cooperating with other human service providers reminds me of our historic issue concerning psychology wrestling market share, if you will, from psychiatrists back in the 60’s and currently seeking prescription privileges that have always been under the purview of duly trained medical doctors. As a psychologist, I have followed this controversy and know that psychologists’ argument for being allowed to write drug prescriptions is based not on their being licensed medical doctors, or being a member of the American Medical Association, but is based on psychologists obtaining additional education and training in prescribing medications. I find it ironic that the psychology profession is apparently blind to the training of another discipline that provides similar services while at the same time espousing that they should be given the privilege of performing a task that is completely outside of their scope of traditional training.
NBCC represents 565 practicing masters level counselors in Indiana who have likely taken testing courses in Indiana’s graduate schools right beside psychology students. I know that this was true when I was a student at Ball State; we regularly had counseling and education students in our psychology assessment classes.
The suggestion that trained nonpsychologists must be supervised by psychologists, by reason of membership and license, is preposterous. In contrast, the American Psychological Association, the American Counseling Association, and the National Board for Certified Counselors all require that members follow an ethical code that prohibits their practicing outside of the scope of their training. Moreover, supervision does not guarantee public welfare. When I worked in a community mental health center in Indiana with a masters degree, I met with my supervising psychologist once a month for less than an hour. This psychologist rarely read my psychological testing reports, but he did sign them. In reality, he did not supervise me and was rarely available if I did need him. Surely the Indiana legislature’s intent is not to continue or support such practice.
We have not been made aware of any public information indicating the misuse by nonpsycholgists of the 237 named tests. It seems reasonable that if such information exists, the Board should supply this information to the counselors in Indiana. Moreover, if such information has been withheld from the counseling professionals of Indiana, we question this judgment. Furthermore, governmental restriction of nonpsychologist professionals who are trained to perform testing, without the rationale for such a restriction, is unfair, misguided, restricts trade, and is simply wrong. Promulgating interorganizational conflict also is wrong, is bad for psychology and counseling, and espouses a bad process. Likewise, collaborating with other professionals creates a powerful force that benefits all the citizens of Indiana.
Upon review of the argument that the Psychology Board needs to restrict testing to only psychologists, we have not read any information regarding “competency” as a reason to administer and interpret, or not administer and interpret specific tests. It makes me think of the practice of surgery. I am unaware of surgeons not allowing other doctors, by right of license or professional membership, to perform surgery. Surely a family practice doctor can cut a nail out of a child’s foot or an ENT can remove tonsils. But, the disciplines generally do their own policing. Eye doctors know not to perform podiatry surgery or they could end up with the proverbial foot in their own mouth. Likewise, counselors do not need psychology to seek governmental control over their ability to deal effectively with counselors who might step outside of the bounds of their training.
Additionally, testing publishers have a system of selling tests only to appropriately trained clinicians. We know that the Executive Director of the Association of Test Publishes (ATP), who also is a psychologist, has presented testimony to this Board in the past that opposes your proposed rule. We assume that you aware that ATP uses a system of self-regulation. These test publishers use a competency-based approach to responding to requests to purchase tests. This lends me to conclude that the Psychology Board believes that the counselors in Indiana and test publishers cannot do their own professional policing.
Furthermore, the Test User Qualifications Working Group, formed by the Joint Committee on Testing Practices (JCTP), has reported that access to psychometric devices should be based on the knowledge and behavior of the test user rather than solely on credentials or job title. JCTP developed a report that indicated that educational efforts, rather than restriction of access, is the most effective way of promoting good test practices. JCTP has further indicated that self-regulation is the model system for test regulation. Incidentally, the JCTP, while a multi-discipline group, is housed in the headquarters of the American Psychological Association.
Regulation by legislative restriction of test use only by psychologists is unrealistic, unnecessarily limiting, and ignores other test users such as mental health counselors. Test misuse is more likely to be a function of a lack of information or misinformation than malfeasance of the specific test user, regardless of professional affiliation. It is more important to examine the relevant training of professionals, not the label of the program from which the training was obtained. This will provide the citizens of Indiana the opportunity to be tested and counseled by the same person if they so choose to pursue such clinical continuity.
Ongoing efforts to generate test user qualifications should focus on competent practice procedures and not specific degrees in a particular mental health discipline, namely psychology or counseling. To speak further, not allowing a nonpsychologist who is trained in psychodiagnosis to diagnose mental health disorders is preposterous. The American Psychiatric Association has reported that the Diagnostic and Statistical Manual of Mental Disorders (DSM) is for use across disciplines in the mental health arena. I have trained thousands of counselors and psychologists in the effective use of the DSM for 15 years and have found counselors and psychologists to be able to learn to use of the DSM appropriately and effectively for the benefit of their clients. Furthermore, we all make mistakes and they are surely not constrained to mental health counseling. For example, in 2002 I provided expert testimony on a legal case where an industrial accident victim was grossly misdiagnosed by a psychologist who was simply serving as a hired gun to save an insurance company money. I am happy to report that the victim was subsequently accurately diagnosed and has received appropriate professional resources as a result.
Suggesting that some mental health professionals should not have the right to administer, score and interpret tests due to being inadequately educated and trained is unfounded. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) has high standards regarding testing and assessment that are adhered to by five universities in Indiana. These standards include theoretical and historical bases of assessment, psychometric statistics, sociocultural factors in testing, and strategies for effectively selecting, administering, scoring, and interpreting tests, regardless of the professional persuasion of the test developer. As a trained accreditation team chair that has examined the implementation of these standards at an Indiana university, I can attest and verify that counselor education testing standards are upheld in Indiana.
After studying the information regarding this restrictive rule, we surmise that such a rule is based on generating practice dollars for psychologists through restriction of professional activity and requiring another profession to be subservient. I believe guild issues such as this should be directly addressed between the various professionals involved and not indirectly legislated. It is unfortunate that the psychologists’ dollars are shrinking, in part, due to managed care companies using nonpsychologists to provide testing services, but this shrinking dollar also is experienced among other nonpsychologist mental health providers. Seeking legislative judgment to restrict counselors from testing in Indiana is not a prudent method to increase revenue streams. We do not believe that it is the intent of the Indiana state legislature to keep counselors from providing a service they learned to perform at Indiana universities. Why would the state subsidize graduate education, pay for it to be accredited, and then legislate its citizen graduates out of practicing what the state requires in their training? The state would not have proposed this, a guild would. A competency-based approach across all mental health professions provides a fair and equal access to testing business as well as protects the citizens of Indiana from licensed but potentially incompetent test administration.
Finally, we ask that you discontinue this restrictive rule and collaborate with Indiana’s professional counselors regarding testing for the citizens of Indiana.
J. Scott Hinkle, Ph.D., NCC, CCMHC, ACS
Attachment: Copy of December 30, 2002, Letter to Health Professions Bureau
C: NBCC Executive Director