EPPP Corruption Across Psychology State Boards in U.S.A.

Special Report BY J.Nelson: Whatever they say it’s about…. it’s about money

There is no evidence that the public is facing some sort of previously unheard of crisis in terms of safety from currently practicing psychologists,” said Dr. Amy Henke after the Association of State and Provincial Psychology Boards (ASPPB) announced that they have decided to add a second national examination for a psychology license.

Dr. Henke is a Director in the Louisiana Psychological Association (LPA) and a member of the Early Career Psychologist Committee. She has taken up the banner for the young doctoral graduates, who will bear the financial and emotional burdens of the proposed new test.

The current exam is a knowledge test called the Examination for Professional Practice in Psychology (EPPP). It costs candidates $687.50. The new test is to measure skills.

Henke took her concerns to the LPA Executive Council in July and the members passed a resolution opposing the new exam, called the EPPP Step 2, or EPPP2.

State boards can do whatever they think best. However, in March 2016, Stephen DeMers, EdD, Chief Executive Officer of ASPPB wrote the boards and it sounded more like a fait accompli.

“I am writing to inform you of an important decision made by the ASPPB Board of Directors (BOD) at their January 2016 meeting. During their meeting, the BOD approved the development and implementation of an examination to assess the competency-based skills necessary at entry-level licensure.”

“We are aware that adoption of this new exam by your jurisdiction will require notification of faculty and students in training programs, applicants, and administrative departments that support your offices,” DeMers wrote.

What’s wrong in this picture? What we discovered is that ASPPB “members” are the 64 state psychology boards. ASPPB owns and sells the EPPP––to those forced to purchase it because they are applying for a psychology license.

And now ASPPB is preparing a second exam in the product line This is not surprising, because the EPPP is their main revenue producer, bringing in over $4M in 2014 and helping to build the company’s Assets to $8M.

What is this convoluted arrangement about? Is the EPPP and the proposed new EPPP2, a service to the public? Or is ASPPB more of a test publisher with it own business goals and profit motives?

Times, looked into some of these issues and here is what we found.

Who is ASPPB? Members Only

ASPPB is a 501(c) tax-exempt corporation whose mission is to, “… enhance services and support its member

jurisdictions in fulfilling their goal of advancing public protection, …”.

Their 2014 tax return indicates that they have 64 voting members. These members are the regulatory boards across the U.S. and Canada. Virtually all state boards are “members.”

ASPPB is not particularly open. “If you are not a member or staff of an ASPPB Member Psychology Regulatory Board or an individual member, you are not eligible to access thisection of our website,” they write. Their conferences are also members only.

The ASPPB sells the EPPP and some other products, such as the Psychology Interjurisdictional Compact (PSYPACT), a service to coordinate psychologists working across state lines.

While state boards are not required to use the EPPP, they uniformly do. The licensing laws require a written exam.

In a Letter of Agreement from ASPPB to the boards in late 2012, ASPPB wrote that the EPPP is “made available as a service to psychology licensure boards that are ASPPB members in good standing as signified by payment of membership dues.” ASPPB owns the intellectual property rights to the EPPP and the data generated by the testing program, the authors also explained.

Prior to 2013 boards contracted with Professional Examination

Service (PES) for delivering the EPPP . Each state or jurisdiction had a contract with PES. But in 2013 ASPPB informed the boards that their contracts with PES were being “replaced with a contract between your jurisdiction and the Association of State and Provincial Psychology Boards.”

In the letter, ASPPB officials wrote, “ASPPB and PES have agreed that it would be simpler and more appropriate for ASPPB to contract directly with the 64 psychology regulatory agencies that are members of ASPPB.”

ASPPB said that the change would be “mutually beneficial because ASPPB can now provide a simplified agreement that is more specific to the needs of psychology licensure boards. In addition, the renewal of contracts is expected to be more efficient…” And, “Finally, as voting members of ASPPB, each jurisdiction exercises more oversight of this important examination service by contracting directly with ASPPB for examination services.”

And ASPPB increased the exam fee, paid solely by the candidates, from $450 to $600.

One undisclosed insider thinks the corporate objective for ASPPB is to be a central source for regulation of psychologists. “They want to ultimately do all the licensing and regulating for psychology,” said the insider. “They want to regulate all the telepsychology.” And, “They want to be the Walmart.”

ASPPB appears to be doing well financially.

In 2014, ASPPB listed a total revenue of $5,527,041. In 2013 it was $2,121,738, in 2012 it was $4,274,419, and in 2011 total revenue was $3,072,643.

The bulk of their sales come from “Program services revenues,” which in 2014 was $4,826,421. This breaks down to $4,505,903 for exams, $162,535 for score reporting fees, $122,463 for certification fees, and $35,520 for registration fees.

ASPPB appears to have one highly profitable product, the EPPP, helping build Total Assets of $8,308,466 (Net Assets $7,073,922) for 2014.

Against these profits they report expenses of $746,051, paid to ProExam of New York City, an independent contractor. While they list 11 employees on their tax form, only four appear to be full-time, compensated $77K, two at $115K, and the director at $227K.

One major expense is travel. In 2014 they reported $863,340 for travel and $222,083 for conferences. According to various records Dr. DeMers traveled to Paris, Oslo, New Zealand, Milan, and to Beijing, to meet with international colleagues.

Also, ASPPB reimburses board members for its conferences, although these expenditures are not listed on the 990 tax form under Expenses for “Payments of travel or entertainment expenses for any federal, state, or local public officials.”

It does not appear to be a concern that this arrangement is taking place. It is listed in minutes and openly discussed. In a June 2016 review of the Louisiana State Board of Examiners of Psychologists (LSBEP), the Legislative Auditor wrote:

“Based on information provided by the Board, the former executive director may have improperly charged $2,343 to the Board for airfare, hotel, baggage, and parking fees related to participation in Association of State and Provincial Psychology Boards (ASPPB) committee meetings during October and November 2014. ASPPB stated it pays for flights, hotel rooms, and associated travel expenses for committee meeting participants, either directly or through reimbursement.”

When and where did the idea for a second test come about, broadening the umbrella of regulation from knowledge to skills, or “competencies?

The insider told the Times, “In 2010 or somewhere around that time they were in New Orleans and they implied that they would be making a lot of money on the new test.”

ASPPB was key in designing the 5th International Congress on Licensure, Certification, and Credentialing of Psychologists, held in Stockhom in 2013, which was to focus on “… defining professional competence rather than specifying curricula or training requirements,” reported the Norwegian Co-chair, who co- chaired with Dr. DeMers. The invitation-only conference was primarily funded by ASPPB.

Dr. Emil Rodolfa, Chair of the Implementation Task Force for the new test, and past president of ASPPB, facilitated. His goal, the Co-chair reported, was to “… inform the diverse national approaches to i. defining, ii. developing, iii. assessing, and iv. certifying …” in the area of competence for psychologists.

So, those interested in regulating became focused on the topic of “competence.” But, was there actually a problem with psychologists’ competence, one that required another ASPPB exam?

Does the Public Need More “Protection” from Psychologists?

Dr. Henke and the LPA resolution point out that multiple checks on competency already exist, and based on the evidence appear to be working to protect the public.

“Trainees are already held to high standards through a variety of benchmarks,” she wrote in the resolution, “including but not limited to: APA approval of doctoral programs, multiple practicums where competency is repeatedly assessed, completion of formal internship training (also approved and regulated by APA and APPIC), and supervised post- doctoral hours obtained prior to licensure. There is no evidence to suggest this is not sufficient for appropriate training.”

The Psychology Practice Act sets multiple hurdles including two years supervision, a written exam, oral exam, background check, and jurisprudence exam. Even then, if the board believes there is a problem, the board can require additional physical and psychological assessments.

However, Dr. Rodolfa questions if these standards are enough, saying that supervisors have “… difficulty providing accurate evaluations of their supervisees to others who may have to evaluate the supervisee’s competency.”

“I am particularly concerned about regulatory boards encroaching ownership of training standards,” Dr. Henke said in an interview with the Times. “The goal of a regulatory board, in my personal opinion, is to provide the least restrictive amount of guidelines possible in order to protect the safety of the public.”

Dr. Rodolfa said, “Licensing boards have a mandate to ensure that the professionals they license are competent. Competence is comprised of the integrated use of knowledge, skills, attitudes and values.”

Where does “competence” end and “negligence” begin, in a board’s charter?

In the Psychology Practice Act, what falls within the board’s responsibility is most clear in the disciplinary standards. These include: abuse of clients, engaging in sexual contact, gross negligence or malpractice, conviction of a felony, deception, fraud, exploitation of clients for personal advantage. Also listed are violations of ethics rules, immoral, unprofessional, or dishonorable conduct, and being unable to practice with “reasonable skill and safety” due to illness, drug abuse, alcohol, mental or physical conditions.

Board’s disciplinary actions and malpractice lawsuits are two sources of information about how well psychologists perform overall.

Based on reported disciplinary actions for a five-year period, there were eight separate disciplinary actions by the Louisiana State Board of Examiners of Psychologists (LSBEP) from 2010 to 2014. (Six of the eight involved child custody.)

This is a rate of 1.6 disciplinary actions for approximately 700 psychologists, or 1 in about 437. The rate goes to virtually zero if compared not by the number of psychologists, but by the estimated number of clients that psychologist sees. Multiplying by a conservative 20 patients/clients per year, then the rate goes to 1 in over 8,000.

Nationwide the rate is also low. In 2014, 168 disciplinary actions were recorded for 106,500 licensed psychologists in that same year, according to reports by ASPPB. This is 1 in 634 for individuals or an estimated 1 in 12,000 patients/clients.

We also examined malpractice payments for psychologists and medical psychologists in Louisiana over the period of 2004 to 2014, based on National Practitioner Data Bank. Five medical malpractice payments were reported. The lowest settlement was $10,000 and the highest was $170,000.

For the same 11-year time period, 21 “Adverse Actions” which include board actions, occurred. This is about 1 in 400.

For psychologists and medical psychologists, and an estimated 1 in 8,000 if using patients/clients.

 

How Much Psychological Science is Really Behind the EPPP?

In her LPA Resolution, Dr. Henke wrote about the EPPP2: “There is no scientific data that support better outcomes regarding patient safety or quality of care. Given that psychologists are uniquely trained to design and create tests, it is concerning that this test is being proposed without any indication of its necessity for either the field or for the safety of the public.”

This problem appears not only an issue for the new test, but also for the current one, the EPPP.

The test development method used by ASPPB is called content validation. For the EPPP, officials at ASPPB ask practicing psychologists to rate the importance of various knowledge areas. Then experts develop items that measure these areas. “These results were used to review and refine the EPPP test specifications to ensure that the knowledge assessed by the EPPP is required for the performance of critical behaviors and serves the public protection function of regulation,” ASPPB officials write.

However, critics say this is not enough. In 2009, Brian Sharpless and Jacques Barber authored “The Examination for Professional Practice in Psychology (EPPP) in the era of evidence-based practice,” for Professional Psychology: Research and Practice.

“Professional psychology has increasingly moved toward evidence-based practice,” said the two authors. “However, instruments used to assess psychologists seeking licensure, such as the Examination for Professional Practice in Psychology (EPPP), have received relatively little empirical scrutiny.”

They write, “… there is a paucity of criterion, predictive, and incremental validity evidence available.” They also examined aspects of the content validation studies and question if the EPPP actually “can meet its stated goals.”

Dr. DeMers responded in the same journal attempting to clarify issues and giving some information not published. He agreed with some of the recommendations, according to the summary of his article.

ASPPB continues to acknowledge the limitations on their webpage, “There is no suggestion that people who do better on the EPPP will be better practitioners.”

Industrial-Organizational Psychologist Dr. William Costelloe, Chair of the I-O and Consulting Psychology Committee of LPA, told the Times, “… predictive validation studies must be conducted.”

“Suppose you own a company that manufactures large industrial valves that can be monitored wirelessly to adjust flow volume from a remote location,” Costelloe said. “You reason that ‘relational skills’ are a required competency for sales. You infer that a candidate with a high Extroversion score will make more sales than a candidate who has a high Introversion score,” he said. “You then administer the MBTI to numerous candidates over time and after looking at the scores you realize that your inference was not only completely wrong but backward.”

“Why? The sales personnel are interacting with mechanical engineers who must make the decision to switch over these new valves. They don’t want to relate. They want specific engineering facts and data and they are introverts. The content and construct validity of the MBTI may suggest that the Introversion/Extroversion dimension does measure introversion/extroversion but there is no predictive validity to suggest that the MBTI should be used as a predictor of sales success.”

“Well conducted, scientifically based predictive validation studies must be conducted if the EPPP2 is intended to be used as a selection tool,” Costelloe said.

Do the Cobbler’s Children Have Shoes?

Is the ASPPB an unbiased, advisory group, or is it a business with its own goals and agendas?

This convoluted arrangement where a corporation, formed of state boards, operates as a test publisher, with influence and special access to government officials, and also a captive market, seems ripe for conflict of interest (COI).

The Times asked one CPA to look over the information and he said, “Of course there is influence and COI.” The state Ethics Board’s rules prohibit arrangements where decisions can be influenced by business connections. It is not clear how this can be justified.

The outcomes suggest the system is flawed. While the EPPP may suffice to measure knowledge, it lacks adequate validation, and it looks like so will the EPPP2.

Fair competition would create downward pressure on the price, and upward pressures toward quality. But without competition, ASPPB has no reason to fold profits back in. A new revenue stream, the EPPP2, with a similarly poor validation plan, seems to be their goal.

“With a lot of cash sitting on the balance sheet, the strategy is to maximize expenses,” said an MBA in reviewing the information for the Times. The extra profits are likely to go into perks rather than price cuts.

While the state boards don’t have to do what ASPPB tells them to do, the social pressures and group-think to conform seem very serious, and boards have neither the time or expertise to analyze the quality issues.

It is ironic that the elite discipline for test development and use, the professionals who literally set the bar for quality, can so far miss the mark, and do so with its own future generations.

That the Early Career Psychologists are taking on this fight, on behalf of the students, is redeeming. Storming the gates of the castle may have uncovered important problems that go deeper than the EPPP2 plans.

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