The APA Council of Representatives (COR) met March 9 and 10, 2018, at the Capital Hilton in Washington, D.C. The meeting focused on several important issues.
The Council Diversity Work Group (CDWG)
The CDWG had prepared an experiential curriculum with the Council Leadership Team (CLT) that they expected to implement through the Council session. My understanding is that shortly before the meeting President Daniel decided not to include the activity on the agenda. Members of the CDWG and others were concerned that the program was not included in the Council agenda.
The Council voted to accept the report of the CDWG.
Clinical Practice Guidelines and Professional Practice Guidelines
Some members of the APA practice science and academic communities have significant concerns about The Clinical Practice Guideline on Post Traumatic Stress Disorders (PTSD) that is the product of a Guideline Development Panel. At the February 2017 meeting, Council approved the guideline with a proviso that APA would promptly prepare a Professional Practice Guideline (PPG) on PTSD. The task was referred to the Board of Professional Affairs (BPA). BPA instead decided to work on a generic PPG document. Following the February meeting there was disagreement among people in attendance about what BPA was charged to do. That issue was not resolved until this Council meeting when Secretary Kelly reported that staff had listened to the audio recording of the meeting and determined that BPA had indeed been charged to write a PTSD specific document not a generic document. The Council voted to accept a revision to the minutes of the February 2017 meeting to correct the error.
Prior to and in the interval between February 2017 and March 2018 Association members across the country expressed concern about the limited scope of the PTSD Guideline and the potential unintended consequences the guidelines could create for practitioners. There is particular concern for those members who use methodologies that do not lend themselves to study by the very limited methodology permitted by the National Guidelines Clearinghouse (NGC). The NGC rules are largely limited to studies using Randomized Controlled Trials (RCT) which effectively means that only CBT treatments will be considered. Members in New Jersey; New York; Psychotherapy Action Network; Divs. 31, 39 & 42; and others wrote to leadership with their concerns. These groups and then additional members developed their own critiques of the guidelines and recommendations to address their concerns. Eventually they connected with the help of Divs. 31 and 42 and began working together. As expected there were differences of opinion, but the groups eventually found consensus around two ideas:
- Developing a super-policy that would address how APA creates guidelines of all kinds and their limitations.
- Recommending that a clear notice be posted on the front of the PTSD Guideline filed at the clearing house that clearly states their limitations
Rather than attempting to summarize complex positions in this article, you can read the documents created by this group onlineopens in new window.
Information posted by APA’s Advisory Steering Committee (ASC) about the PTSD Guideline and guideline development is available on APA’s website.
The group of members who have concerns about the guideline development process generated a New Business Item (NBI) for Council. They were too late to ask that the item be placed on the formal agenda for the March meeting. The group then sought to have Council add the item to the agenda at the meeting. To do that required either unanimous consent or a 2/3 vote of the Council membership.
There was considerable discussion of the guideline on the Council listserv prior to the meeting and at the Council. June Feder (NY) and Fred Wertz (D24) made a motion to have the NBI included on the agenda. There were some questions about the appropriate procedure that were eventually addressed. The proposal did not get anywhere close to the support it needed to be added to the agenda, and thus there was no formal discussion of the concerns and recommendations of the group.
The Guideline for the Behavioral Treatment of Obesity in Children and Adolescents was on the agenda for the second day of the session. That item provided the opportunity to discuss some of the general concerns that members have about guideline development and the limitations of the National Clearinghouse Guidelines, as well as some specific concerns about the Obesity Guideline (factors related to body shaming, fat oppression, links between trauma and obesity and the differential impact of obesity on marginalized communities). It is concerning that while this guideline clearly states that there is very little research in this area it included treatment recommendations. The Council approved the guideline by a significant margin.
Some of the members involved in guideline development and some of the people with concerns are interested in having discussions to see if they can find a mutually satisfactory resolution to these concerns. We are in the process of trying to connect with them for ongoing discussions. The BOD and CLT have also shared that they are considering having the guidelines issue be a “mega-issue discussion” at the next Council. Hopefully, there will be a way to address these concerns in a manner that is satisfactory to a great majority of the membership. If that does not occur, I am concerned that a significant segment of the membership may decide that APA is putting a lot of money and effort into creating policies that are not helpful to them or are detrimental to their interests as they are at risk to be used by others to seek to undermine the validity and credibility of their work.
Master’s Education and Credentialing
For 70 years APA has not taken a position on whether master’s degree programs should be accredited, and whether APA should endorse credentialing people with master’s degrees with a credential that would enable them to engage in independent practice (with perhaps limitations on their scope of practice and title, and potentially requirements for supervision). The issue is being pressed now as the Council for Accreditation of Counseling & Related Educational Programs (CACREP), the organization that credentials counseling education programs, is seeking to prohibit psychology faculty from teaching in their accredited counseling programs, and to change licensing laws to exclude people with master’s degrees in psychology from being licensed as master’s level counselors.
Understandably APA members who educate master’s students are concerned about their students’ ability to work after graduation, as well as their own job security. Universities also make money from master’s programs not doctoral programs. So institutions have a financial interest in this as well. Some members also see credentialing master’s degree holders as a way to encourage people who do not want to get a doctorate to be healthcare service providers and to have more people willing to work in underserved areas.
However, this agenda has implications for doctoral psychologists that have not been given anywhere near the consideration it is due. Psychology in healthcare services could become a master’s level workforce with some doctoral psychologists continuing to be researchers, educators and - for a limited time - administrators.
The March 2018 agenda stated that at the August 2017 meeting Council voted that, “APA should take a position on master’s level training and/or practice. As part of Council’s charge to staff and governance to identify and explore options for APA to pursue, staff reached out to a select group of key stakeholders in late fall 2017 to collect feedback in advance of wider dissemination to Council. In January 2018, webinars were offered to collect feedback from Council members. The information gathered during those webinars informed the development of the main motion that is currently before Council for consideration.” Council charged leadership, “to identify and explore options for APA to pursue.” Executive Directors Katherine Nordal (Practice) and Jaime “Jim” Diaz-Granados (Education) were selected to lead that workgroup. The workgroup offered a series of webinars for stakeholders. The webinar identified, “serious implications to be: that graduates of master’s programs will not have a path to licensure and that their employment opportunities would be limited, that master’s and doctoral programs might not be viable, and that there would be reduced access to services to those in need.”
I have significant concerns about how the issue got to this place at the Council:
After the August 2017 Council meeting the workgroup had assembled a set of documents relative to these issues. Those documents were shared with the Committee for the Advancement of Professional Practice (CAPP). Three CAPP members (including me) reviewed the material and presented to CAPP issues and further questions generated from those materials and other sources. A significant portion of those questions were guild issues. CAPP asked the workgroup to attempt to answer the questions that the subcommittee developed. The workgroup did not attempt to answer the questions posed by CAPP. Further, the information gathered by the workgroup was not shared with Council members prior to the meeting by staff or Council Leadership Team (CLT), nor were the issues or questions raised by CAPP included in the webinars.
Recognizing that this information had not been provided to Council, I wrote CLT Chair Joseph Coyne with my concern that Council members did not have adequate information to make informed decisions, and I indicated my intention to ask that the matter be referred to the Board of Educational Affairs (BEA), the Membership Committee and CAPP to gather and report additional information. I shared this letter on the Council Listserv. In the week prior to the meeting, Katherine Nordal gave me permission to share the documents the Workgroup had collected with Council, which I did.
The basis for the motion on the March agenda was cited as, “select group of key stakeholders in late fall 2017 to collect feedback in advance of wider dissemination to Council. In January 2018, webinars were offered to collect feedback from Council members. The information gathered during those webinars informed the development of the main motion that is currently before Council for consideration.” The workgroup reported responses to survey questions that members completed after watching the webinar that was based solely on information chosen by the workgroup. The sample size was consistently an N of only 28 (people who had just watched the webinar).
The agenda for the March 2018 meeting contained the following motion: “that Council supports pursuing accreditation of master’s level programs in psychology.” To me that was quite a leap from the August 2017 charge. After the item was initially presented I rose to make a substitute motion to refer as I had indicated. My substitute motion was solidly defeated and the main motion passed with a substantial majority.
It is my understanding that APA will now pursue a process of developing accreditation standards for masters’ programs. It is evident that the accreditation standards for healthcare service degrees will be created with the intent of linking accreditation to licensing. I expect that accreditation standards will be created to match the model scope of practice for people with masters’ degrees and that Council’s approval of a policy endorsing licensure for people with masters’ degrees will be presented to Council as necessary and inevitable.
APA should be starting this discussion from consideration of what job skills in the realm of psychology are needed and best served by a person with a master’s degree rather than a doctoral degree, and what are the workforce needs for these skills. Rather, in my view, the driving consideration is what can APA do to support members and educational institutions that benefit from the existing system of educating master’s students. APA also stands to benefit from a new class of master’s members. The interests and future of doctoral psychologists and the overall future of the profession have barely been given a passing thought in this process. I do appreciate the desire to support professional psychology to serve underserved populations and places, but this is not the only way to do it. There is no reason to expect people trained at a master’s level to serve underserved populations any more than doctoral psychologists or any other profession. How about financial incentives or loan forgiveness programs to encourage doctoral psychologists to work with underserved communities?
The documents I referencedopens in new window are available to you online. The folder contains my letter to Joseph Coyne and my follow up email to the Council members.
Here again, I am concerned that a significant segment of the membership may decide that APA is putting a lot of money and effort into creating policies that are at a minimum not helpful to them or even detrimental to their interests.
Transformation
The Council was asked to approve the concept of transforming membership so that members are members of both the APA (c)(3) and a transformed APAPO (c)(6) organization. The APAPO has continued to lose membership and revenue. In its current form it won’t survive more than a couple of years at best. APA has been looking for ways to support and enhance advocacy for the entire organization. Members of governance groups have expressed concern that Council was asked to approve the concept without knowledge of the details of how the transformation would be accomplished and the new organization governed. The Council voted in support of the transformation. The yet unarticulated details will matter.
Features of the transformation include:
- Members will automatically be members of both the (c)(3) and (c)(6) with payment of their dues.
- Dues will be maintained at the same rate for the next three years. Small increases are projected after that.
- The APAPO dues will be retired. Members of the APAPO will have an immediate reduction of their dues by $140.
- Dues will be paid to a third-party organization. Some as yet undetermined governance structure will decide how to split the dues between the two organizations each year.
- Through the new (c)(6) entity, APA will be able to lobby in all areas of psychology without the (c)(3) limitations with which it now contends. And the association will have the ability to better coordinate advocacy among all realms of the organization.
A few weeks ago, President Daniel appointed a task force to articulate the details of the plan.
Transparency
The Work Group to Review Organizational Policies and Procedures made a motion to require the association to record and post the individual votes of all the BOD, CLT, Council, boards and committees. The proponents viewed this motion as a way to increase governance transparency and accountability. Leadership opposed the motion as costly and potentially undermining participant’s ability to vote their fiduciary responsibility to APA in favor of satisfying their perceived constituency. The motion was adapted to remove boards and committees, and then postponed to next year.
Finance Rules
The Council voted to postpone a motion about changing finance rules until August. The Council had a long discussion about the reason and implications of the proposed changes. The Council postponed further consideration to the next meeting.
Other Issues
- The Council reviewed the content of the Multicultural Guidelines that were accepted by Council last August.
- Council approved the Resolution on Pregnant and Postpartum Adolescent Girls and Women with Substance Use Disorders.
I am concerned about the future of the association, our profession and our professional futures. The guidelines, the master’s accreditation and credentialing issue, and the transformation each have the potential to benefit constituencies of APA’s membership to the detriment of other constituencies of the association. It is important that our association be thoughtful about the impact these choices may bring.