THE MISSISSIPPI LEGISLATURE

The Joint Committee on

Performance Evaluation and Expenditure Review

Report # 503

A Review of the Board of Psychology

Executive Summary

Introduction

PEER reviewed the Mississippi Board of Psychology (hereafter referred to as “the board”). PEER conducted the review pursuant to the authority granted by MISS. CODE ANN. Section 5-3-57 et seq. (1972). This review is a “cycle review,” which is not driven by specific complaints or allegations of misconduct.

PEER first established the public need for regulation of the psychology profession, then evaluated how well the board carries out its two primary regulatory functions to protect the public: licensing psychologists and handling complaints/investigations. PEER also reviewed the board’s financial management practices.

Background

According to MISS. CODE ANN. Section 73-31-1 (1972), the Legislature created the Board of Psychology to “safeguard life, health, property, and the public welfare in Mississippi in order to protect the people of this state against unauthorized, unqualified, and improper applications of psychology.” Currently, the board regulates approximately 390 psychologists in the state.

The board is composed of seven members appointed by the Governor: one member who is not a psychologist or mental health professional but who has expressed an interest in the field of psychology; three who are faculty at institutions of higher learning that grant doctoral degrees, or staff or faculty of an American Psychological Association-approved doctoral-level internship; and three who are engaged in the professional practice of psychology.

The board contracts for a full-time Board Administrator, who uses an employee of another state agency as an accounting assistant. (The Board Administrator personally provides payment to the accounting assistant, who has no contractual relationship with the board.) Additionally, the board retains legal assistance from a representative of the Attorney General’s office, who assists with administrative hearings and provides legal advice.

As a special fund agency, the board’s revenues are generated from fees charged for licensure application, examination, and annual license renewal. The board’s expenditures have exceeded revenues in three of the last five fiscal years. FY 2006 revenues were $96,542 and FY 2006 expenditures were $101,415.

Conclusions Regarding the Board’s Regulation of the Practice of Psychology

Regulation of the psychology profession is necessary to reduce risks to the public. PEER found several provisions of state law, as well as the Board of Psychology’s licensure process, that should be improved to strengthen regulation of psychologists. Also, the board should maintain a log of complaints against licensees, increase the public’s awareness of disciplinary actions taken, and correct problems with its own financial management.

Needed Improvements in Licensure of Psychologists

Needed Improvements in State Law Regarding Licensure of Psychologists

Because some of state law’s licensure requirements for psychologists differ from those of states with which Mississippi has reciprocity agreements, the board cannot ensure that all licensees enter the profession at the same level of competence. Professional groups have called into question the necessity of postdoctoral experience (which Mississippi law requires) as a licensure requirement, as well as an examination of knowledge of the history of psychology (which Mississippi law also requires). Also, state law does not specifically authorize the board to perform background checks on applicants for licensure.

Needed Improvements in the Board’s Licensure Process

Because of problems with its content and administration, the board’s oral examination adds minimal value to the evaluation of licensure applicants. The board’s process for utilizing the recommendations of supervisors of post-doctoral supervised experience does not ensure that applicants possess the minimum competencies needed to practice. Also, the process for collecting reference information and the instruments used provide little, if any, utility in determining an applicant’s readiness for independent practice and could ultimately delay the licensure process.

Needed Improvements in the Complaints Process

Because the board does not maintain a log of complaint information, it cannot easily assess its own performance in protecting the public. The Board Administrator created a database of complaint information in response to PEER’s request; however, prior to that request, the board did not maintain a master log of complaint information. Because the board does not maintain a complaint log, it is unable to report easily the number of complaints within any given period, effectively monitor the status of complaints to ensure timeliness of resolution, analyze trends in complaint information that might provide rationale for potential statutory or policy changes, track licensees’ competence over time, or ultimately assess its own performance.

Needed Improvements in Increasing Public Awareness

Because the board does not provide information that is easily accessible to the public regarding disciplinary actions taken against licensees, the board limits the public’s and licensed psychologists’ awareness of rules infractions and their consequences. The only method the board uses to disseminate information to the public regarding sanctions is to respond to requests. The public could choose a psychologist from the board’s online directory and unknowingly obtain counseling services from psychologists who have had sanctions against them, thereby placing themselves at an increased risk of harm, depending on the reason for the sanction.

Problems with Financial Management

The Board of Psychology has not established a proper internal control environment to ensure the integrity of its accounting and financial reporting processes and compliance with state timely deposits requirements.

The management of an organization is responsible for establishing proper internal controls. During its review, PEER found deficiencies in three areas of the board’s financial operations: separation of accounting duties, timely deposit of cash receipts into the State Treasury, and monitoring of expenses and financial reporting.

The board’s lack of separation of accounting duties violates state agency accounting policies and procedures set forth by the Department of Finance and Administration and compromises the accuracy and completeness of the board’s accounting records. Because of this condition, the board cannot ensure the public that its operations are reasonably free from fraud.

Contrary to MISS. CODE ANN. Section 7-9-21 (1972), the Department of Finance and Administration’s policy, and the State Auditor’s 2003 recommendations, the board does not always transfer daily collections in excess of $1,000 from the clearing account to the State Treasury by the next business day or make weekly settlements of amounts less than $1,000.

Also, the board’s practice of allowing the Board Administrator to be reimbursed for board operating expenses prevents members from monitoring the agency’s expenses and knowing the agency’s actual costs of operations.

Administrative Issues of the Regulatory Boards for Mississippi’s Mental Health Professions

The boards responsible for regulating three of Mississippi’s mental health professions have suffered from conditions such as a lack of permanent staffing, lack of a permanent office location, and insufficient in-house accounting expertise. These deficiencies have impacted the boards’ administrative and financial operations. The boards could benefit from a solution that would allow them to pool resources to address common needs and problems.

In addition to this review, PEER has also recently reviewed the Board of Examiners for Licensed Professional Counselors and Board of Examiners for Social Workers and Marriage and Family Therapists. As described in these reports, all three regulatory boards have managerial and financial deficiencies that limit their effectiveness in protecting the state’s citizens and providing services to their respective practitioners:

• Two of the boards—Licensed Professional Counselors and Psychology—do not have office locations in the Jackson metropolitan area, thereby limiting their accessibility to practitioners and the public.
• Two of the boards—Licensed Professional Counselors and Psychology—lack permanent office staff, relying instead on contract administrators. The limited number of administrative staff of each board contributes to internal control problems for the boards, primarily with regard to the separation of accounting duties.
• Contract administrators for the boards of Licensed Professional Counselors and Psychology acknowledged that they have limited knowledge of the state’s accounting system and subcontract with personnel of other state agencies to enter these boards’ accounting information into the state system.
• Within recent years, all three regulatory boards have been cited by the State Auditor for failing to comply with the state’s timely deposits requirements for transferring funds from clearing accounts to the State Treasury within periods designated by state law or Department of Finance and Administration policies.
• Due to the use of contract staffing and the staffs’ unfamiliarity with the state’s accounting system, members of the boards sometimes have received limited financial information with which to make programmatic and resource allocation decisions.

In view of the potential for mismanagement or theft of resources, a solution to the problems cited above is both possible and desirable. Such solution could allow the three boards to pool resources to address common needs and problems.

Overlap in the Scopes of Practice of Mississippi’s Mental Health Professions

Significant overlap in the scopes of practice in Mississippi of psychologists, counselors, social workers, and marriage and family therapists, along with a lack of definition for the unique competencies that define each field, could cause confusion for the public when deciding which professionals are competent to treat certain disorders. Further, some mental health professionals may be engaging in practices in which they have not been properly trained.

PEER found that the statutory statements of scopes of practice of these four mental health professions overlap significantly. Each of these professions may involve the assessment/diagnosis and treatment of mental and emotional disorders. The overlapping of psychology with the other three professions is noted in MISS. CODE ANN. Section 73-31-27 (1972), which states:

The practice of psychology overlaps with the activities of other professional groups and it is not the intent of this act to regulate them.

In Mississippi, a psychologist is authorized by state law to assess personal characteristics and change or improve behavior or mental health through psychotherapy procedures (e. g., psychoanalysis, biofeedback). However, psychotherapy and psychotherapeutic techniques are also specifically mentioned as part of the scopes of social workers (in the board’s Rules and Regulations) and of marriage and family therapists (in MISS. CODE ANN. Section 73-54-5 [b] [1972]). Although not specifically mentioned in the law or Rules and Regulations of the Board of Examiners for Licensed Professional Counselors, licensed counselors are not prohibited from engaging in psychotherapy, provided that psychotherapy is within the boundaries of their competence.

The overlap in scope of practice would not prove to be a problem in a situation in which all regulated mental health professions recognize common training standards for attaining competency in a given area of practice. However, in Mississippi the licensed mental health professions have not established mutually agreed upon training requirements by service area, nor have they clearly defined boundaries of practice. Such an approach is not in the best interest of the consuming public.

Recommendations

1. By the 2010 legislative session, the Board of Psychology should present sound evidence supporting either the maintenance or modification of the state’s educational, experience, and examination requirements for licensure.1
   
   Specifically, if the board believes that the state should maintain its current requirements, the board should provide sound evidence to demonstrate that:
   
   
   • individuals who graduate from designated programs (as opposed to APA-accredited programs) are not competent to practice psychology at an entry level;
   • individuals who receive 3,000 hours of experience (as opposed to 4,000 hours) are not competent to practice psychology at an entry level;
   • individuals who complete a 1,500 hour internship (as opposed to 2,000 hours) are not competent to practice psychology at an entry level; and,
   • the post-doctoral year of supervised experience (as opposed to two years pre-doctoral experience) is needed to ensure competence in practicing psychology at an entry level.
   
   If the board presents sufficient evidence to maintain the present licensure requirements, then the board should eliminate its acceptance of the CPQ and the ASPPB’s Agreement of Reciprocity and instead enter into reciprocity agreements only with states that have equivalent education and experience requirements.
   
   If the board does not present sufficient evidence to maintain the present licensure requirements, then the Legislature should consider amending MISS. CODE ANN. Section 73-31-9 (1972) to require that applicants meet only the minimum educational, experience, and examination standards needed to practice psychology competently, as established through research.
2. The Legislature should amend MISS. CODE ANN. 73-31-13 (1972) to remove the requirement that the board’s examination measure knowledge in the history of psychology.
3. The Legislature should amend MISS. CODE ANN. Section 73-31-13 (c) (1972) to require the following:
   
   
   • that the board conduct background checks on all applicants for licensure;
   • that for purposes of these background checks, “good moral character” shall be established by an absence of felony convictions or convictions for misdemeanors involving moral turpitude; and,
   • that the board may request the assistance of the Department of Public Safety, as well as consulting sex offender registries, in checking criminal histories of applicants.
   
   Additionally, the board should provide to the Legislature for its consideration a list of criminal violations that should disqualify a person from receiving a license.
4. The board should immediately revise the structure and administration of its oral examination in accordance with the ASPPB’s Oral Examination Guidelines.
5. The board should consider administering a written jurisprudence examination covering Mississippi law in addition to a valid oral examination.
6. To comply with MISS. CODE ANN. Section 73-31-13 (1972), the board should establish in its Rules and Regulations a passing score for its oral examination.
7. To ensure that applicants have the necessary competencies to practice psychology through quality supervised experience, the board should add the ASPPB’s Supervision Guidelines, section entitled Guidelines for Supervision of Doctoral Level Candidates for Licensure, to its Rules and Regulations.
8. The board should eliminate the licensure requirement for professional references and instead require a more thorough evaluation from clinical supervisors, as described in the ASPPB’s Supervision Guidelines.
9. To improve the board’s maintenance of complaint information, the Legislature should consider amending Title 73, Chapter 31, of the MISSISSIPPI CODE to require that the board maintain a log of every complaint received to include: the case number, the complainant’s name, the licensee’s name, the nature of the complaint, the names of investigators, the date assigned to investigators, the results of the complaint, any disciplinary action taken, and the date closed.
10. The board should make information on final disciplinary orders and sanctions readily available to the public through the board’s website and in a periodic newsletter distributed to licensees.
11. The board should immediately adopt policies, procedures, and oversight controls to:
    
    
    • ensure that the contract administrator records and accounts for all remittances received by the board immediately upon their receipt;
    • require an independent verification, possibly with the assistance of the board’s officers, of the Board Administrator’s recording of and depositing of cash receipts into the board’s bank clearing account;
    • ensure that someone other than the Board Administrator (possibly a board member) reconciles the monthly statement for the bank clearing account; and,
    • comply with state law and state agency accounting policies and procedures by depositing all collections into the State Treasury when such collections reach $1,000 or on a weekly basis.
12. In order to monitor the agency’s financial operations, the board should require that all operating expenses be paid and accounted for through the Statewide Automated Accounting System (SAAS), rather than on a reimbursement basis. Such an arrangement would allow operating expenses to be pre-audited prior to payment and categorized properly according to type of expense.
13. To address the administrative problems cited in this report and in two recently released PEER reports (#497, A Review of the Board of Examiners for Licensed Professional Counselors, and #501, A Review of the Board of Examiners for Social Workers and Marriage and Family Therapists), the Legislature should create an Executive Committee for the Board of Psychology, the Board of Examiners for Social Workers and Marriage and Family Therapists, and the Board of Examiners for Licensed Professional Counselors consisting of the chairs of each of the three boards.
    
    The Executive Committee should be responsible for developing a plan to manage the administrative support of the three boards. The Executive Committee should design an efficient, effective component to provide administrative support. In developing the administrative component, the Executive Committee should take the following steps:
    
    
    1. Determine what type of administrative support (including staffing and resources) is necessary to correct the administrative problems common to the three boards.
    2. Determine the cost of providing this administrative support.
    3. Determine how to distribute equitably the costs of administrative support among the three boards.
    
    Such administrative support activity should include the following:
    
    
    • the housing of staff and records for the three boards in a single location in the Jackson metropolitan area;
    • the selection of a single executive director to support the three boards;
    • the selection of clerks, bookkeepers, and other personnel necessary to carry out the financial management and other administrative functions of the three boards; and,
    • the selection of an investigator or investigators to support the three boards in reviewing and investigating complaints of misconduct.
    
    In furtherance of these ends, the Executive Committee should become custodian of all funds appropriated to the three boards and should have the sole authority to expend funds in the names of the three boards.
    
    PEER believes that because economies of scale should be achieved by combining the administration of the three boards, the boards should be able to set up and operate the administrative support component with current fee structures. If not, the respective boards should increase annual fees, charging licensees their pro rata share in amounts sufficient to cover the costs of the administrative support component.
    
    The Executive Committee should also make recommendations to the Legislature regarding any changes in law needed to facilitate administrative consolidation of the three boards.
    
    Administrative consolidation should not address such matters as disciplinary hearings and penalties, rule making, fee setting, and the submission of annual budget requests, which shall remain the individual responsibilities of the three boards.
14. The Legislature should create a task force composed of members of the Board of Examiners for Social Workers and Marriage and Family Therapists, the Board of Examiners for Licensed Professional Counselors, and the Board of Psychology.
    
    The task force should make recommendations no later than November 1, 2008, to the PEER Committee regarding how to remedy the problems related to overlapping scopes of practice for Mississippi’s mental health professionals, as well as contradictions and imprecision in laws related to scope of practice. The task force’s recommendations should include proposed revisions to existing law.
    
    Subsequently, the PEER Committee should report the efforts of the task force and make accompanying recommendations to the Senate Public Health and Welfare Committee and the House Public Health and Human Services Committee no later than January 1, 2009.

‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾

1 An example of a process for validating the education- and experience-based minimum qualifications may be found in the Autumn 2005 edition of Personnel Psychology, Volume 58, pages 771-799.

PEER Home Page         Full Text PDF (5,775K)