TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF PSYCHOLOGY

Fast-Track Regulation

Title of Regulation: 18VAC125-20. Regulations Governing the Practice of Psychology (amending 18VAC125-20-54, 18VAC125-20-65).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: August 14, 2024.

Effective Date: August 29, 2024.

Agency Contact: Jaime Hoyle, Executive Director, Board of Psychology, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4406, FAX (804) 327-4435, or email jaime.hoyle@dhp.virginia.gov.

Basis: Regulations of the Board of Psychology are promulgated under § 54.1-2400 of the Code of Virginia, which authorizes health regulatory boards to promulgate regulations that are reasonable and necessary to effectively administer the regulatory system.

Purpose: The impetus for this action is the board's desire to ensure more individuals can apply for licensure as a clinical psychologist in Virginia. This increases the number of available psychologists in the Commonwealth, which protects the public health, safety, and welfare.

Rationale for Using Fast-Track Rulemaking Process: This action should be noncontroversial because it reduces barriers to licensure.

Substance: These amendments allow school psychologists who have obtained a doctorate to obtain a license in clinical psychology in Virginia. Additionally, the changes allow a resident studying school psychology to be supervised by a clinical psychologist.

Issues: The primary advantage to the public is a potentially increased workforce of clinical psychologists. There are no disadvantages to the public. There are no primary advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. The Board of Psychology (board) proposes to make two discretionary amendments that would reduce barriers to licensure as a clinical psychologist or school psychologist in Virginia.

Background. A 2022 report by the Virginia Health Care Foundation highlighted the ways in which the COVID-19 pandemic exacerbated the shortage of behavioral health services in the Commonwealth.² The Department of Health Professions (DHP) reports that this board (like other behavioral health boards) is trying to reduce barriers to licensure while ensuring that licensed professionals are adequately trained for the level of services they provide. At its September 2022 meeting, the board's Regulatory Committee recommended amending the regulations to allow a doctoral-level school psychologist to be licensed as a clinical psychologist to reduce barriers to licensure for that profession.³ In addition, the board discussed the need to change the regulations to allow for individuals seeking licensure as a school psychologist to be supervised by a clinical psychologist.

The regulation provides for three licensure categories (clinical, applied, and school psychologists) and each category has different requirements. Currently, the regulation requires clinical psychologists to hold a doctorate in clinical or counseling psychology, and school psychologists to hold either a master's degree in school psychology or a master's degree from a psychology program that meets certain criteria listed in section 56 of 18VAC125-20. DHP reports that some school psychologists obtain a doctorate in school psychology, and that the doctoral-level programs in clinical, counseling, and school psychology provide very similar training. Accordingly, the board seeks to allow individuals with a doctorate in school psychology to become licensed as clinical psychologists. Specifically, the board proposes to amend section 54 (Education requirements for clinical psychologists) to include school psychology under the requirement that an applicant shall "hold a doctorate in clinical or counseling psychology from a professional psychology program" that meets the accreditation requirements specified in that section.⁴ The proposed amendments would also include school psychology in the educational programs specified in subsection D of that section.

Further, the board proposes to amend 18VAC125-20-65 (Residency) so that a resident seeking licensure as a school psychologist may be supervised by a clinical psychologist. This would partially relax the current requirement that supervisors be licensed to practice in the same licensure category in which the resident is seeking licensure, and increase flexibility for candidates seeking a school psychologist license.

Estimated Benefits and Costs. Starting June 23, 2028, the proposed changes would also benefit individuals with doctorates in school psychology by allowing them to become licensed as clinical psychologists. In the interim, this proposed change would benefit individuals for whom obtaining a doctorate in school psychology would be easier than obtaining a doctorate in clinical or counseling psychology (which may vary depending on their master's degree and the programs available to them) by providing them with a pathway to licensure as a clinical psychologist once they complete their doctorate. The proposed changes would also benefit individuals currently seeking licensure as school psychologists by providing more flexibility in finding acceptable supervisors to meet their residency requirement. Lastly, employers of licensed clinical and school psychologists as well as the patients they serve would benefit to the extent that the proposed changes increase the supply of licensed professionals. Educational institutions that meet the accreditation requirements of this regulation and provide doctoral programs in school psychology may also benefit to the extent that the proposed changes result in an increase in enrollment. The proposed amendments would not create any new net costs.

Businesses and Other Entities Affected. The proposed amendments would directly benefit both licensed school psychologists with doctorates and residents seeking licensure in school psychology. As of June 30, 2023, there were 103 licensed school psychologists and 27 residents in school psychology.⁵ VDH does not collect data on the number of licensed school psychologists with doctorates in their field. A 2022 DHP report shows that 50% of licensed clinical psychologists primarily engage in private practice, and that the other 50% are employed by various health care and behavioral health care facilities.⁶ These facilities would benefit to the extent that new licensees with doctorates in school psychology and new residents in those programs seek employment.

The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁷ An adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined. As described, the proposed changes would not create any new net costs. Thus, an adverse impact is not indicated.

Small Businesses⁸ Affected.⁹ The proposed amendments are not expected to adversely affect small businesses.

Localities¹⁰ Affected.¹¹ The proposed amendments neither appear to disproportionately affect any particular localities nor introduce costs for local governments.

Projected Impact on Employment. The proposed amendments are not likely to have a substantive impact on total employment; however, the number of licensed clinical and school psychologists and their employment would likely increase.

Effects on the Use and Value of Private Property. By reducing the barriers to becoming a clinical psychologist, the proposed regulation may increase the supply of clinical psychologists, which could lower hiring costs for private firms that employ them. Thus, the value of some such firms may moderately increase. The proposed amendments do not affect real estate development costs.

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¹Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² See this 2022 report from the Virginia Health Care Foundation: https://www.vhcf.org/2022/01/19/new-assessment-finds-alarming-shortage-of-virginia-licensed-behavioral-health-professionals-and-outlines-attainable-solutions/.

³ See https://townhall.virginia.gov/l/GetFile.cfm?File=meeting\31\32900\Minutes_DHP_ 32900_v2.pdf.

⁴ This provision would have a delayed effective date of June 23, 2028, which was added to this section in a 2021 regulatory action. See https://townhall.virginia.gov/l/ ViewAction.cfm?actionid=4897.

⁵ Source: https://www.dhp.virginia.gov/about/stats/2023Q4/04CurrentLicenseCount Q4FY2023.pdf.

⁶ See https://www.dhp.virginia.gov/media/dhpweb/docs/hwdc/behsci/0810CP2022.pdf.

⁷ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

⁸ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁹ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

¹⁰ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

¹¹ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency's Response to Economic Impact Analysis: The Board of Psychology concurs with the economic impact analysis prepared by the Department of Planning and Budget. The board would like to clarify, however, that the three types of psychology licenses in the Commonwealth are dictated by § 54.1-3606 of the Code of Virginia. The regulation mirrors statute, producing the three required license types.

Summary:

The amendments allow (i) school psychologists who have obtained a doctorate to obtain a license in clinical psychology in Virginia and (ii) a resident studying school psychology to be supervised by a clinical psychologist.

18VAC125-20-54. Education requirements for clinical psychologists.

A. Beginning June 23, 2028, an applicant shall hold a doctorate in clinical or, counseling, or school psychology from a professional psychology program in a regionally accredited university that was accredited at the time the applicant graduated from the program by the APA, CPA, or an accrediting body acceptable to the board. Graduates of programs that are not within the United States or Canada shall provide documentation from an acceptable credential evaluation service that provides information verifying that the program is substantially equivalent to an APA-accredited program.

B. Prior to June 23, 2028, an applicant shall either hold a doctorate from an accredited program, as specified in subsection A of this section, or shall hold a doctorate from a professional psychology program that documents that the program offers education and training that prepares individuals for the practice of clinical psychology as defined in § 54.1-3600 of the Code of Virginia and meets the following criteria:

1. The program is within an institution of higher education accredited by an accrediting agency recognized by the U.S. Department of Education or publicly recognized by the Association of Universities and Colleges of Canada as a member in good standing. Graduates of programs that are not within the United States or Canada must provide documentation from an acceptable credential evaluation service that provides information that allows the board to determine if the program meets the requirements set forth in this chapter.

2. The program shall be recognizable as an organized entity within the institution.

3. The program shall be an integrated, organized sequence of study with an identifiable psychology faculty and a psychologist directly responsible for the program and shall have an identifiable body of students who are matriculated in that program for a degree. The faculty shall be accessible to students and provide them with guidance and supervision. The faculty shall provide appropriate professional role models and engage in actions that promote the student's acquisition of knowledge, skills, and competencies consistent with the program's training goals.

4. The program shall encompass a minimum of three academic years of full-time graduate study or the equivalent thereof.

5. The program shall include a general core curriculum containing a minimum of three or more graduate semester hours or five or more graduate quarter hours in each of the following substantive content areas:

a. Biological bases of behavior (e.g., physiological psychology, comparative psychology, neuropsychology, sensation and perception, health psychology, pharmacology, neuroanatomy).

b. Cognitive-affective bases of behavior (e.g., learning theory, cognition, motivation, emotion).

c. Social bases of behavior (e.g., social psychology, group processes, organizational and systems theory, community and preventive psychology, multicultural issues).

d. Psychological measurement.

e. Research methodology.

f. Techniques of data analysis.

g. Professional standards and ethics.

6. The program shall include a minimum of at least three or more graduate semester credit hours or five or more graduate quarter hours in each of the following clinical psychology content areas:

a. Individual differences in behavior (e.g., personality theory, cultural difference and diversity).

b. Human development (e.g., child, adolescent, geriatric psychology).

c. Dysfunctional behavior, abnormal behavior, or psychopathology.

d. Theories and methods of intellectual assessment and diagnosis.

e. Theories and methods of personality assessment and diagnosis, including its practical application.

f. Effective interventions and evaluating the efficacy of interventions.

C. Applicants shall submit documentation of having successfully completed practicum experiences involving assessment, diagnosis, and psychological interventions. The practicum experiences shall include a minimum of nine graduate semester hours or 15 or more graduate quarter hours or equivalent in appropriate settings to ensure a wide range of supervised training and educational experiences.

D. An applicant shall graduate from an educational program in clinical, counseling, or school psychology that includes an appropriate emphasis on and experience in the diagnosis and treatment of persons with moderate to severe mental disorders.

E. Candidates for clinical psychologist licensure shall have successfully completed an internship in a program that is either accredited by APA or CPA, or is a member of APPIC, or the Association of State and Provincial Psychology Boards/National Register of Health Service Psychologists, or one that meets equivalent standards. If the internship was obtained in an educational program outside of the United States or Canada, a credentialing service approved by the board shall verify equivalency to an internship in an APA-accredited program.

F. An applicant for a clinical license may fulfill the residency requirement of 1,500 hours, or some part thereof, as required for licensure in 18VAC125-20-65, in the doctoral practicum supervised experience, which occurs prior to the internship, and that meets the following standards:

1. The supervised professional experience shall be part of an organized sequence of training within the applicant's doctoral program that meets the criteria specified in this section.

2. The supervised experience shall include face-to-face direct client services, service-related activities, and supporting activities.

a. "Face-to-face direct client services" means treatment or intervention, assessment, and interviewing of clients.

b. "Service-related activities" means scoring, reporting or treatment note writing, and consultation related to face-to-face direct services.

c. "Supporting activities" means time spent under supervision of face-to-face direct services and service-related activities provided onsite on site or in the trainee's academic department, as well as didactic experiences, such as laboratories or seminars, directly related to such services or activities.

3. In order for pre-doctoral practicum hours to fulfill all or part of the residency requirement, the following shall apply:

a. Not less than one-quarter of the hours shall be spent in providing face-to-face direct client services;

b. Not less than one-half of the hours shall be in a combination of face-to-face direct service hours and hours spent in service-related activities; and

c. The remainder of the hours may be spent in a combination of face-to-face direct services, service-related activities, and supporting activities.

4. A minimum of one hour of individual face-to-face supervision shall be provided for every eight hours of supervised professional experience spent in direct client contact and service-related activities.

5. Two hours of group supervision with up to five practicum students may be substituted for one hour of individual supervision. In no case shall the hours of individual supervision be less than one-half of the total hours of supervision.

6. The hours of pre-doctoral supervised experience reported by an applicant shall be certified by the program's director of clinical training on a form provided by the board.

7. If the supervised experience hours completed in a series of practicum experiences do not total 1,500 hours or if a candidate is deficient in any of the categories of hours, a candidate shall fulfill the remainder of the hours by meeting requirements specified in 18VAC125-20-65.

18VAC125-20-65. Residency.

A. Candidates for clinical or school psychologist licensure shall have successfully completed a residency consisting of a minimum of 1,500 hours of supervised experience in the delivery of clinical or school psychology services acceptable to the board.

1. For clinical psychology candidates, the hours of supervised practicum experiences in a doctoral program may be counted toward the residency hours, as specified in 18VAC125-20-54. Hours acquired during the required internship shall not be counted toward the 1,500 residency hours. If the supervised experience hours completed in a practicum do not total 1,500 hours or if a candidate is deficient in any of the categories of hours, a candidate may fulfill the remainder of the hours by meeting requirements specified in subsection B of this section.

2. School psychologist candidates shall complete all the residency requirements after receipt of their final school psychology degree.

B. Residency requirements.

1. Candidates for clinical or school psychologist licensure shall have successfully completed a residency consisting of a minimum of 1,500 hours in a period of not less than 12 months and not to exceed three years of supervised experience in the delivery of clinical or school psychology services acceptable to the board, or the applicant may request approval to extend a residency if there were extenuating circumstances that precluded completion within three years.

2. Supervised experience obtained in Virginia without prior written board approval will not be accepted toward licensure. Candidates shall not begin the residency until after completion of the required degree as set forth in 18VAC125-20-54 or 18VAC125-20-56.

3. In order to have the residency accepted for licensure, an individual who proposes to obtain supervised post-degree experience in Virginia shall register with the board prior to the onset of such supervision by submission of:

a. A supervisory contract along with the application package;

b. The registration of supervision fee set forth in 18VAC125-20-30; and

c. An official transcript documenting completion of educational requirements as set forth in 18VAC125-20-54 or 18VAC125-20-56 as applicable.

4. If board approval was required for supervised experience obtained in another United States jurisdiction or Canada in which residency hours were obtained, a candidate shall provide evidence of board approval from such jurisdiction.

5. There shall be a minimum of two hours of individual supervision per 40 hours of supervised experience. Group supervision of up to five residents may be substituted for one of the two hours on the basis that two hours of group supervision equals one hour of individual supervision, but in no case shall the resident receive less than one hour of individual supervision per 40 hours.

6. Supervision shall be provided by a psychologist who holds a current, unrestricted license in the jurisdiction in which supervision is being provided and who is licensed to practice in the licensure category in which the resident is seeking licensure; however, a resident seeking licensure as a school psychologist may be supervised by a clinical psychologist.

7. The supervisor shall not provide supervision for activities beyond the supervisor's demonstrable areas of competence nor for activities for which the applicant has not had appropriate education and training.

8. The supervising psychologist shall maintain records of supervision performed and shall regularly review and co-sign case notes written by the supervised resident during the residency period. At the end of the residency training period, the supervisor shall submit to the board a written evaluation of the applicant's performance.

9. The board may consider special requests in the event that the regulations create an undue burden in regard to geography or disability that limits the resident's access to qualified supervisors.

C. Residents shall not refer to or identify themselves as clinical psychologists or school psychologists, independently solicit clients, bill directly for services, or in any way represent themselves as licensed psychologists. Notwithstanding, this does not preclude supervisors or employing institutions from billing for the services of an appropriately identified resident. During the residency period, residents shall use their names, the initials of their degree, and the title "Resident in Psychology" in the licensure category in which licensure is sought.