YES! The NC Psychology Board has supported this and initially proposed the rule change to have a pathway for LPAs to practice independently. The only reason this was not changed is because RRC determined it would require change in statute. We have written documentation from the NC Psychology Board supporting the end of LIFETIME supervision.
Insurance companies will only panel independent practitioners.
We have had no direct contact with the APA; however, the APA has a history of considering the Ph.D as the entry level to psychology, and though this may be changing, it appears this continues to be their stance.
Having a pathway to independence for LPAs would open access to more affordable psychological services to residents of NC. State institutions such as prisons and state hospitals would be positively impacted with time or decreased expenses. Ending LIFETIME supervision would create no cost for the state.
This would have no impact on already practicing LPA’s.
NC has a need for increased access to psychological services, particularly in rural areas, now.
The NC Psychology Practice Act already specifies education and training requirements. This will not change because of anything the NCPA or APA does. Any education change requirements would require a change to the NCAC and/or General Statute.
There is no time line on if or when APA accreditation would happen.
This is not a turf war. This is about decreasing regulatory burden to increase access to psychological services.
ANY supervision, even it's only 4 hours per year, blocks access to care. Specifically, required supervision means that our license is "restricted" and we can not get credentialed with many insurance providers, meaning, people can't use insurance to pay for services. Rural and non-urban areas are hit particularly hard by this, where psychological services are not widely available. LPAs could help fill the gaps.
The petition is a 103 page legal document brought forth by a team of four Licensed Psychological Associates and two Licensed Psychologists. Since it is a legal filing, it was constructed by Ed Gaskins, Esq. and associates of the law firm Everett Gaskins Hancock LLP, in Raleigh. The document petitions the North Carolina Psychology Board to exercise their authority to make rules changes within the North Carolina Psychology Practice Act regarding the current requirement of career-long supervision for Licensed Psychological Associates (LPA), amending it such that LPAs have a pathway to independence after three years of supervised practice.
NCAPP – North Carolina Association of Professional Psychologists
Non-profit agency advocating for psychologists in North Carolina – in particular, master’s level practitioners. NCAPP’s focus has been removing community barriers to psychological services in NC by advocating for master’s level psychologists to practice independently by creating a path to unrestricted licensure and, as a result, eligibility to contract with major insurance companies in NC.
NCPA – North Carolina Psychological Association
Non-profit agency representing psychologists in North Carolina.
NCPA has requested that the petitioners withdraw the petition and not pursue LPA independence at this time. The NCPA is questioning the quality of education and EPPP scores/passage rates of LPAs and does not believe that LPA independence should be pursued before the APA determines measures and national standards. The NCPA has sought legal counsel to oppose our current petition seeking immediate LPA independence before the NCPB
APA – American Psychological Association
Non-profit national agency representing psychologists. The APA continues to hold firm that the minimum level of education necessary to practice psychology is the doctorate. While they are currently looking into the possibility of accreditation for master’s psychology programs, preliminary reports indicate that master’s level practioners will be limited in scope of practice (e.g. behavior specialists).
NCPB - North Carolina Psychology Board
State agency directed to carry out provisions of the North Carolina Psychology Practice Act. In 2019 the NCPB submitted proposal for rules changes to the NC Rules Review Commission, to provide a pathway for independence for LPAs/master’s level psychologists.
RRC – Rules Review Commission (of North Carolina)
The executive agency created by the General Assembly charged with reviewing and approving rules adopted by state agencies as it relates to proposed rules’ legality.
Les Brinson, PhD, LP, HSP-P
Vinston Goldman, PhD, LP, HSP-P
Janet Heuring Larsen, MA, LCAS, LPA, CCTP
Carol E. Williams, MA, LPA, BCBA
Tara Luellen, MA, LPA, HSP-PA
Flora Dunbar, MA, LPC, LPA
The legal team recommended that a small group of petitioners, no more than five or six, work to draft and sign the petition. Official affidavits needed to be drafted and notarized for each petitioner, and the affidavit was included in the petition, which the legal team knew could eventually become a document for court review should legal action be needed. Dr. Goldman, Dr. Brinson, Mrs. Heuring Larsen, Ms. Williams, Ms. Luellen, and Ms. Dunbar followed the directions of the legal team very carefully and kept the petition within their small group until it was ready to be submitted to the North Carolina Psychology Board. Another reason the petition was not made public knowledge upfront to include other interested LPAs, was that the legal fees and time to do so would be extraordinary and cost-prohibitive. Because the six petitioners cover a broad spectrum of practice, experience, and levels within the discipline, the legal team felt the six petitioners would be an excellent sample to represent the matter of ending career-long supervision.
Very briefly, in 2015, Mrs. Heuring Larsen, Ms. Williams, and Ms. Luellen sought consultation from Ms. Dunbar and other former members of North Carolina Association of Professional Psychologists (NCAPP) leadership to explain the current supervision issues and the barriers to practice psychology for LPAs. Former NCAPP leadership educated and provided the start-up resources to what became the current NCAPP leadership, who were interested in finding a different approach to ending career-long supervision and increasing access to LPAs and psychological services across NC. This led to the careful selection of a highly experienced and award-winning legal team led by Ed Gaskins Esq. and his law firm Everett Gaskins Hancock, LLP.
Ed Gaskin’s law firm worked with the petitioners for nearly two years learning about the issues of career-long supervision, the history behind the former unsuccessful attempts change it, and the differences between how LPAs are treated in their area of behavioral health compared to other master’s and doctoral level practitioners. Hundreds of journal articles, letters, and documents were reviewed and considered to be helpful or included in the final petition. Mr. Gaskins had 30 years of litigation and other relevant experience in dealing with health boards in NC. He examined the matter of career-long supervision and concluded that the current requirement is in violation of Federal Anti-trust law, and thus, a small group of psychologists were recommended to raise the issue with the North Carolina Psychology Board.
Affidavits were drafted and notarized with the help of the legal team, and data were collected and assimilated into the final petition. On August 15, 2018, the petition to end career-long supervision for LPAs was officially submitted to the North Carolina Psychology Board (NCPB). On November 15, 2018, at the NCPB meeting in Raleigh, NC, the petitioners, a videographer, a stenographer, and the legal team were present to review the petition in person with the NCPB. Five out of seven NCPB members openly expressed support for the petition. The NCPB officially denied the request to make a rule change following the November 2018 meeting in order to further review the matter and review other rules that could be impacted by LPA independence. Therefore, an appeal of their decision was filed with the Superior Court of North Carolina as a matter of proper legal procedure. This appeal was put on hold when it became apparent that the NCPB was working on the issue and amenable to making a rule change following their review of supervision rules within the North Carolina Psychology Practice Act. Subsequent to the petitioners meeting with the NCPB in January of 2019, and their own deliberations, the NCPB submitted a proposed rule change with the North Carolina Rules Review Commission (RRC) that parallels the petition for a rule change submitted by the petitioners. Currently, the proposed rule change submitted by the NCPB is before the RRC to be put on their agenda.
UPDATE: While the NCPB supports the end of LIFETIME supervision, the RRC in a split decision, objected to the NCPBs authority to make the change. We are focused now on addressing this toward a path to independence.
All money donated and all membership fees are applied to the legal fees assessed by Everett Gaskins Hancock LLP for the petition and associated matters to end career-long supervision for LPAs. Any other costs associated with this matter have been absorbed by Mrs. Heuring Larsen, Ms. Williams, and Ms. Luellen.
Most of the expenses being incurred are legal fees. Other fees include website costs, typical business expenses (business cards, correspondence, etc), travel fees, conference fees, etc. These additional costs above and beyond the legal fees have been paid in full by Mrs. Heuring Larsen, Ms. Williams, and Ms. Luellen. The petitioners together have also donated hundreds of dollars of their own money toward the legal fees in addition to spending hundreds of hours working with the legal team and operating NCAPP. This effort has occupied their time for the last four years. The first two years was spent reviewing the literature, exploring data, reviewing documents, and strategizing a plan of action. The last two years has been spent executing a plan of action as directed by Ed Gaskin Esq. and his legal team.
Ed Gaskins of Everett Gaskins Hancock LLP has been a pillar of support from the inception of this effort. The legal team behind this petition recognizes the inequity and unfairness of career-long supervision, as well as the potential benefit to those seeking mental health services from psychologists across the state when LPAs are no longer restricted by license. As such, they have been generous with granting some latitude on paying the fees associated with this effort, with the understanding that all the fees will be paid and the team is doing their best to generate the support of other LPAs and interested persons through donations and membership fees. It is essential that everyone contribute as much as they can. Thus far, a small percentage of LPAs and LPs have borne the burden of the costs associated that will benefit all current and future psychologists. There are over 900 LPAs in North Carolina. If even half of those LPAs contributed $100, the legal fees would be met for the next year at least. Please donate and encourage others to do so also.
All LPAs and citizens of North Carolina will benefit from this rule change. LPAs will have independence such that they may practice within the scope of their expertise in any capacity they choose. They will not be constrained by costs associated with supervision fees, nor will they be prevented from being credentialed as providers by insurance panels due to a restricted license. LPAs will be able to volunteer services with organizations such as the Red Cross and other service agencies that currently prohibit such work due to the restricted license. Citizens underserved in rural and non-urban areas will have greater access to psychologists. This action benefits psychology by creating opportunities and contributing to the field. As we all benefit, we all should do our part as best we can. LPAs will also be able to finally be eligible to gain access to eight of the 10 major insurance carriers in NC who deny LPAs because of the “restricted” licensure status that they hold.
The legal team of Everett Gaskins Hancock LLP has extensive experience in the area of fair trade and has represented others for and against various North Carolina Boards. They reviewed the North Carolina Psychology Practice Act and conferred with a number of their legal peers. They all agreed the statute allows for the North Carolina Psychology Board to make the rule change. The North Carolina Psychology Board concurs.
UPDATE: The RRC, in a split decision, does not agree. WE are working toward changing this.
No psychologist is obligated to reduce their level of supervision. The rule change allows for independence should an LPA choose to pursue it. All LPAs and LPs are encouraged to consult with peers as a matter of good practice and in keeping with ethical concerns; however, this change allows for doing so without associated fees. To be clear, respectful and equitable consultation with peers is not to be confused with required supervision and the associated financial burdens borne by the LPA or employer.
Nothing in this effort is related to titles. It is not part of the rule change, has nothing to do with the rule change, and it does not appear to be within the scope of the authority of the North Carolina Psychology Board to change LPAs’ title.
As of now, we have no indication that the American Psychological Association (APA) supports the petition.
The NCPA has requested that the petitioners withdraw the petition and not pursue LPA independence at this time. The NCPA is questioning the quality of LPAs' education and EPPP scores/passage rates of LPAs, and does not believe that LPA independence should be pursued before the APA determines measures and national standards. The NCPA has sought legal counsel to oppose the current petition seeking immediate LPA independence before the NCPB.
That said, the petition solely involves rules within the North Carolina Psychology Board (NCPB) and the North Carolina Psychology Practice Act; both organizations governed by North Carolina state legislation. While the petitioners would prefer that NCPA support this effort and that the organization would advocate for LPAs’ equity in practice and parity with other master’s level practitioners (e.g. LCSW, LCS, LCAS, etc), the petition is a legal matter and is not subject to rules, guidelines, or views specified by the APA or NCPA.
The legal team representing the petitioners, Everett Gaskins Hancock LLP, is confident that the petition stands on firm precedents and is in keeping with North Carolina statute and Federal Anti-trust laws. State Boards are not immune from Federal Anti-trust laws and all rules are required to be continued as a matter of public safety rather than control of the marketplace by a dominant group. Should the petition involve court action, there is every reason to believe that the petitioners will prevail across multiple levels of court, and could potentially seek reparations, including all legal fees incurred.
The proposed rule change must be reviewed by the North Carolina Rules Review Commission to ensure it is consistent with current statute, that it does not conflict with any other statute, and that it is legal. The North Carolina Psychology Board will then proceed with the changes.
UPDATE; The change didn't make it through RRC. We are revising our path and continue to strive toward independence. We will update you as we are able.
There is no specific timeline currently such that anyone could say the process will be completed by “X” date. Once the North Carolina Rules Review Commission acts on the proposed rule, providing there are no legal or constitutional concerns raised, the matter will be presented at the next meeting of the North Carolina Psychology Board. They would be expected to continue the process in a reasonable timeframe given the legal ramifications.
Supervision has been reduced, effective January 01.2021, but the fight continues. We will work on this until LPAs have a path to independence. Currently, we have a plan and we are in the process. As our actions become more public, we will update the site and our NCAPP members.
Email us to get involved! firstname.lastname@example.org