Some things NOT to do

[ClinicalABA]

From a recent case:

-Don't refer to yourself with a made-up title, especially one that is misleading about your licensure status (e.g., "Licensed Clinical Psychologist"). Especially don't do so if you are not an appropriately Licensed Psychologist-Provider who is properly trained and credentialed to complete a diagnostic assessment, but rather hold a different license (e.g., Licensed Educational Psychologist) that does not allow for independent diagnostic evals outside of an educational setting. Such behavior will get you reported to the board of Registration of Psychologists due to potentially practicing psychology without a license.

-Don't be squirrely and make families think you are doing an actual autism diagnostic assessment (and are qualified/credentialed to do so), and then avoid ANY mention of diagnosis in your report (including ruling anything out). Don't do this as a backhanded way to get the family to show the report to a pediatrician, who will then provide a diagnosis that will only qualify the child for services up through age 3. Don't then refer the child to non-insurance covered services that your agency provides with language guaranteeing improvement if the child receives such services. Such behavior will get you reported not only to the Psychology Board (for reasons identified above), as well as to the board that actually oversees your licensed (e.g., the Department of Education).

-In a further attempt to be squirrely and avoid the issue of given/not giving a formal diagnosis, don't tell the family verbally (but not in writing) that their child pretty much meets criteria for ASD, but that it is not possible to make that diagnosis because the child is under 2 years old (!). See above for consequences of such actions. Also- watch your back.

-Don't allow your credentials to be misrepresented on your agency's website (e.g., where you are listed as "Licensed Clinical Psychologists [sic]"- also not a real licensed category in this jurisdiction. cf. Licensed Neuropsychologist). If your agency insists on doing this, find another agency to work for, as the board will eventually come after you.

-If your agency has a policy of misleading clients into thinking they are getting something that they are not, find another agency, as the board will eventually come after you.

-If all of the above is done ultimately in the name of increasing market share so that the PE firm that owns your agency (or it's parent company) can then sell it to a different PE agency, making above market rate returns for investors, yet passing unmanageable debt onto to the next "owners", who will then pass it on, eventually, to the poor shmucks actually trying to provide services, ultimately reducing the quality of services (or eliminating them entirely), then please enjoy your seat in hell.

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[AbnormalPsych]

-Don't allow your credentials to be misrepresented on your agency's website (e.g., where you are listed as "Licensed Clinical Psychologists [sic]"- also not a real licensed category in this jurisdiction. cf. Licensed Neuropsychologist). If your agency insists on doing this, find another agency to work for, as the board will eventually come after you.

I see this all time time, but have not once seen or heard a board investigate or act on this. Have others?

 

[cara susanna]

I hope you weren't personally involved in this, ClinicalABA*! That sounds so stressful.

*want to clarify that I'm referring to the agency stuff, not the individual practitioner stuff

 

[R. Matey]

We get many of these reminders in an email at least once a year from our state org's legal counsel.

I have seen ppl get blacklisted for misrepresenting their credentials, not for misrepresenting their competence.

 

[ClinicalABA]

I see this all time time, but have not once seen or heard a board investigate or act on this. Have others?

I have seen the board act on the website thing where clinicians are misrepresented as being licensed. My state board has also been historically rather strict regarding anything that looks like an attempt to subvert licensure requirements, like getting a different license that makes you seen like your're a Licensed Psychologist Provider, but really aren't, or are selling yourself as a Doctoral Level Psychologist when you are licensed at the masters level but also happen to have a doctorate in something else.

 

[AbnormalPsych]

Ah, yes. I have seen board action for people completely unlicensed or with expired licenses, just not the title switching / modification games.

 

[ClinicalABA]

I hope you weren't personally involved in this, ClinicalABA*! That sounds so stressful.

*want to clarify that I'm referring to the agency stuff, not the individual practitioner stuff

Fortunately, my agency is trying to do things right. I have informally addressed some similar stuff with my agency (e.g., a page on our website where the link and title was "Our Psychologists," but the page included bios of non-licensed fellows. The case above first came to my attention when the early intervention worker (who I was involved in a different case with), asked me if it was now not possible to diagnose ASD under 2, and then asked if this were a case she could refer to me. Not knowing the details, I said yes, but the family would need to check with the insurance company about getting a second opinion and having an assessment repeated (with some CPT codes billed) within an 6 month period. Family checked, and there were never any codes billed for this assessment!! They told family to preceded with referral to me and have me put the testing auth request through as a regular initial testing auth, rather than second opinion. I have since done the intake, seen the report from previous testing, and heard the family and early intervention therapist report of what happened at the previous assessment (including that the actual face-to-face time spent with child was less than 20 minutes, despite reportedly doing a full ADOS-2).

 

[ClinicalABA]

We get many of these reminders in an email at least once a year from our state org's legal counsel.

I have seen ppl get blacklisted for misrepresenting their credentials, not for misrepresenting their competence.

Credentialed vs Competent is a tough one. This person may have been competent to administer and interpret the ADOS. They did conclude that the child was showing "moderate-to-severe" deficits in social communication and reciprocity, with a significant pattern of repetitive and sensory avoidant behaviors." They just never mentioned in writing anything about a diagnosis (sounds a bit like ASD, don't you think? Though I'll do a few more direct tests and parent surveys to be sure to cover some of the rule-outs). The also signed the report "Licensed Educational Psychologist," which is their actual license. In giving the ADOS to a toddler, they may have very well been acting within their competence, but doing it at a community clinic under the guise of an actual diagnostic assessment that would qualify child for insurance funded ABA services they were acting outside their scope of practice as dictated by their credential. Looking at the report, they do title the document "Clinical Psychological Assessment." Aside from that not being an actually defined thing (or what they did), it implies "clinical psychology" which is not their training or licensure. It could easily be misconstrued by the client and public that this was a diagnostic assessment completed by an appropriately licensed psychologist. I also think it was done intentionally shady.

 

[MiniLop]

Feeling a little attacked right now.

 

[ClinicalABA]

I have since spoken with my boss about this. This is apparently an MO of this agency (though other clinicians seem appropriately licensed). Have an non credentialed staff do an ADOS and write a brief report. Then- and only then- tell family to show it to their pediatrician and ask for and ASD diagnosis so kiddo can start ABA services. Family (and early intervention coordinators who are the primary referral source) think they are getting an actual diagnostic assessment by an appropriately licensed psychologist. They've already been taken off (or never put on) the long waitlists for real assessments. Pretty shady. There are some pediatricians and early intervention programs that work together (and our honest with families) to have a social worker or other trained clinician conduct an ADOS, and the pediatrician uses that info to give an ASD diagnosis (qualifying a child for under 3 ABA), all while still referring for an actual assessment so that child qualifies for insurance funded services after 3. That's fine.

 

[ClinicalABA]

Feeling a little attacked right now.

by what?

 

[Sanman]

Feeling a little attacked right now.

Because Easter is gone and no one cares about bunnies anymore?

 

[ClinicalABA]

Feeling a little attacked right now.

by what?

Did I just commit another error of misreading internet humor/sarcasm (e.g., @MiniLop jokingly pretending to be the person I was talking about) or did I just commit another error of unintentionally insulting someone on the internet?

Or... is @MiniLop the actual person I was referencing in the OP (dun dun dun)!?!

 

[Sanman]

Did I just commit another error of misreading internet humor/sarcasm (e.g., @MiniLop jokingly pretending to be the person I was talking about) or did I just commit another error of unintentionally insulting someone on the internet?

Or... is @MiniLop the actual person I was referencing in the OP (dun dun dun)!?!

It is your ultra conservative political ideologies that offend...

 

[R. Matey]

Credentialed vs Competent is a tough one. This person may have been competent to administer and interpret the ADOS. They did conclude that the child was showing "moderate-to-severe" deficits in social communication and reciprocity, with a significant pattern of repetitive and sensory avoidant behaviors." They just never mentioned in writing anything about a diagnosis (sounds a bit like ASD, don't you think? Though I'll do a few more direct tests and parent surveys to be sure to cover some of the rule-outs). The also signed the report "Licensed Educational Psychologist," which is their actual license. In giving the ADOS to a toddler, they may have very well been acting within their competence, but doing it at a community clinic under the guise of an actual diagnostic assessment that would qualify child for insurance funded ABA services they were acting outside their scope of practice as dictated by their credential. Looking at the report, they do title the document "Clinical Psychological Assessment." Aside from that not being an actually defined thing (or what they did), it implies "clinical psychology" which is not their training or licensure. It could easily be misconstrued by the client and public that this was a diagnostic assessment completed by an appropriately licensed psychologist. I also think it was done intentionally shady.

Sounds sus (to borrow a phrase from the youths). Curious though: Is this the Ed.S. license in your state or is this person a Ph.D./Psy.D. level school psychologist?

 

[ClinicalABA]

Sounds sus (to borrow a phrase from the youths). Curious though: Is this the Ed.S. license in your state or is this person a Ph.D./Psy.D. level school psychologist?

It's licensure through the department of education, rather than the department of professional licensure based board of psychology. It's basically licensure as a school psychologist, which requires a masters, CAGS, or doctoral degree. Graduates of doctoral level School Psychology programs which meet APA standards (e.g. appropriate curriculum; advanced practica; predoctoral internship) who have passed EPPP and jurisprudence can be licensed as a "Licensed Psychologist Provider" (identical licensure to grads of clinical or counseling psych phd/psyd programs). This is NOT that. This person knows that, as do her supervisors. They are skirting licensure laws and misleading families, giving a different story verbally than in writing (eg in their reports).

 

[R. Matey]

It's licensure through the department of education, rather than the department of professional licensure based board of psychology. It's basically licensure as a school psychologist, which requires a masters, CAGS, or doctoral degree. Graduates of doctoral level School Psychology programs which meet APA standards (e.g. appropriate curriculum; advanced practica; predoctoral internship) who have passed EPPP and jurisprudence can be licensed as a "Licensed Psychologist Provider" (identical licensure to grads of clinical or counseling psych phd/psyd programs). This is NOT that. This person knows that, as do her supervisors. They are skirting licensure laws and misleading families, giving a different story verbally than in writing (eg in their reports).

Yeah, the school psychs in our department had the option of pursing either with the vast majority choosing to go through APPIC to obtain independent psychologist license. My understanding is this license (at least where I went to grad school) doesn't cover independent practice outside of the schools. I knew a psychometrist a while back with this license, but she didn't use it for her position.

Hella sus. No cap.

 

[futureapppsy2]

Yeah, the school psychs in our department had the option of pursing either with the vast majority choosing to go through APPIC to obtain independent psychologist license. My understanding is this license (at least where I went to grad school) doesn't cover independent practice outside of the schools. I knew a psychometrist a while back with this license, but she didn't use it for her position.

Hella sus. No cap.

IIRC, every PhD/PsyD school psych can choose to pursue licensure as a psychologist if they wish (and if the state allows it, which I *think* they all do at this point)--many former classmates who have only ever worked in schools, minus a practicum here or there, are licensed psychologists in addition to school psych licensure and NCSP certification. Of course, their scope of practice is limited ethically to children and adolescents,

 

[WisNeuro]

IIRC, every PhD/PsyD school psych can choose to pursue licensure as a psychologist if they wish (and if the state allows it, which I *think* they all do at this point)--many former classmates who have only ever worked in schools, minus a practicum here or there, are licensed psychologists in addition to school psych licensure and NCSP certification. Of course, their scope of practice is limited ethically to children and adolescents,

There are a lot of "School Neuropsychologists" out there running concussion clinics, for all ages.

 

[R. Matey]

IIRC, every PhD/PsyD school psych can choose to pursue licensure as a psychologist if they wish (and if the state allows it, which I *think* they all do at this point)--many former classmates who have only ever worked in schools, minus a practicum here or there, are licensed psychologists in addition to school psych licensure and NCSP certification. Of course, their scope of practice is limited ethically to children and adolescents,

I've seen it both ways with some of the school folks I know who operate independently do so with only their psychologist licenses. I'm LPC eligible on account of my M.A. degree, but it isn't worth the money nor any potential legal quagmire to hold both simultaneously.

 

[ClinicalABA]

IIRC, every PhD/PsyD school psych can choose to pursue licensure as a psychologist if they wish (and if the state allows it, which I *think* they all do at this point)--many former classmates who have only ever worked in schools, minus a practicum here or there, are licensed psychologists in addition to school psych licensure and NCSP certification. Of course, their scope of practice is limited ethically to children and adolescents,

Definitely the case here. However the doctoral program obviously needs to meet curriculum standards, and the individual must meet minimum standards for practica, internship, etc. For example, my predoc internship cohort included 2 students from the school psychology doctoral program at the same university where I attended my clinical psych program. We all did major rotation in school consultation. My minor rotation was adult outpatient, theirs was child outpatient and private special education school, in line with our clinical training. Similarly, there were two licensed pschologist providers at my last job who both did the exact same work (including diagnosing ASD)- myself and a graduate of the above-mentioned school psych program. Now, that school psych doctoral program had two tracks- one to qualify you to be a licensed psychologist provider (same as me and my clinical/counseling compadres), which allows for independent private practice in community and other settings (including schools), and one to qualify you be a licensed educational psychologist, with your practice more limited in scope as well as to primary school based services. Graduates of the latter would not be eligible for the same licensure as the former, though graduates of the former may be eligible for licensurecas the latter (I currently have a coworker who went to a different school psych program and is licensed as both a licensed psychologist provider and a licensed educational psychologist (though can do pretty much anything with the former that she could do with the latter, but not vice versa!). It can get pretty confusing! Regardless, as you mention you still need to practice within the scope of your competence, regardless of licensure. Pertinent to the case of the OP, based on the laws I my state, insurance companies require a diagnosis by a licensed psychologist provider (or a qualified physician) to pay for ABA.

TLDR- you're correct, as long it is the right kind of school psychology program

 

[MiniLop]

Or... is @MiniLop the actual person I was referencing in the OP (dun dun dun)!?!

You'll be hearing from my lawyer.

 

[futureapppsy2]

Definitely the case here. However the doctoral program obviously needs to meet curriculum standards, and the individual must meet minimum standards for practica, internship, etc. For example, my predoc internship cohort included 2 students from the school psychology doctoral program at the same university where I attended my clinical psych program. We all did major rotation in school consultation. My minor rotation was adult outpatient, theirs was child outpatient and private special education school, in line with our clinical training. Similarly, there were two licensed pschologist providers at my last job who both did the exact same work (including diagnosing ASD)- myself and a graduate of the above-mentioned school psych program. Now, that school psych doctoral program had two tracks- one to qualify you to be a licensed psychologist provider (same as me and my clinical/counseling compadres), which allows for independent private practice in community and other settings (including schools), and one to qualify you be a licensed educational psychologist, with your practice more limited in scope as well as to primary school based services. Graduates of the latter would not be eligible for the same licensure as the former, though graduates of the former may be eligible for licensurecas the latter (I currently have a coworker who went to a different school psych program and is licensed as both a licensed psychologist provider and a licensed educational psychologist (though can do pretty much anything with the former that she could do with the latter, but not vice versa!). It can get pretty confusing! Regardless, as you mention you still need to practice within the scope of your competence, regardless of licensure. Pertinent to the case of the OP, based on the laws I my state, insurance companies require a diagnosis by a licensed psychologist provider (or a qualified physician) to pay for ABA.

TLDR- you're correct, as long it is the right kind of school psychology program

I've never heard of a school psychology PhD program that tracks like that, though I don't doubt that some exist--if you only want to work in schools, it doesn't make since to choose a PhD program over an EdS, except if there's funding in consideration (but even then, the time cost question comes into play). Back when I applied in 2010, there were definite between-program distinctions in school-focused versus clinically-focused school psych PhD programs, but people from any accredited program could ultimately choose to go for psych licensure if they wanted to.

 

[borne_before]

I have since spoken with my boss about this. This is apparently an MO of this agency (though other clinicians seem appropriately licensed). Have an non credentialed staff do an ADOS and write a brief report. Then- and only then- tell family to show it to their pediatrician and ask for and ASD diagnosis so kiddo can start ABA services. Family (and early intervention coordinators who are the primary referral source) think they are getting an actual diagnostic assessment by an appropriately licensed psychologist. They've already been taken off (or never put on) the long waitlists for real assessments. Pretty shady. There are some pediatricians and early intervention programs that work together (and our honest with families) to have a social worker or other trained clinician conduct an ADOS, and the pediatrician uses that info to give an ASD diagnosis (qualifying a child for under 3 ABA), all while still referring for an actual assessment so that child qualifies for insurance funded services after 3. That's fine.

This is the modus operandi of a couple of ABA PE-backed firms in my state. Does this one have an alphabet name?

 

[borne_before]

I've never heard of a school psychology PhD program that tracks like that, though I don't doubt that some exist--if you only want to work in schools, it doesn't make since to choose a PhD program over an EdS, except if there's funding in consideration (but even then, the time cost question comes into play). Back when I applied in 2010, there were definite between-program distinctions in school-focused versus clinically-focused school psych PhD programs, but people from any accredited program could ultimately choose to go for psych licensure if they wanted to.

I haven't really hear about that either, but it makes some sense.

In my program - there was the doctoral cohort, of about 8-10 people and the EdS cohort of about 10 - 20 people. We took overlapping classes the first year or two and then the training diverged heavily into more research/intervention.

Of the doc students, about half already had an EdS or equivalent (masters + school psych certification) and wanted that doctoral degree. Most of that cluster did not go on the APPIC rollercoaster and continue to work in schools post graduation. They were generally older, but wanted that doc degree for some reason. I see some of them pop up from time to time on board minutes requesting to take EPPP but few seem to make it licensure.

A few of the doc students washed out and went after the EdS. I know a couple of people in the other cohorts who even finished coursework, went to an APA internship, but just couldn't finish it. Maybe they like being in a school?

Then there, were, and how to charitably put it, but those school psychology doc students who ended up getting licensure and most work outside of schools. They tended to be better at research, driven, etc. They're either teaching or doing solid work as testing psychologists, some therapy, etc.

 

[ClinicalABA]

This is the modus operandi of a couple of ABA PE-backed firms in my state. Does this one have an alphabet name?

This one is only in New England and New York.