The enhanced EPPP (EPPP: Step 2)

Why the enhanced EPPP (EPPP Step 1+ EPPP Step 2)?

The object of the enhanced EPPP is to create universal standards across the jurisdictions to aid mobility as psychologists change jurisdictions or temporarily practice in a jurisdiction where they are not licensed (ASPPB 2020). The purpose is to focus on assessing clinical skills from practice experiences (i.e., practica, internships, postdoctoral fellowships) of candidates for licensure.

By adding a second, skills-based assessment of competency, psychology will be more aligned with competency assessment models used for other doctoral-level healthcare professionals (such as physicians).The enhanced EPPP will strengthen psychologists’ arguments when lobbying third-party payers for reimbursement coverage and government agencies for federal programs.

There are upfront costs for developing Step 2 of the EPPP, and ASPPB has lowered the cost of the enhanced EPPP-Step 2 to $450, which is significant as the new test uses more expensive technology than Step 1 (meaning ASPPB is not profiting from the test). The enhanced EPPP is currently in a beta testing phase, with an estimated go-live date of Jan. 1, 2022, for jurisdictions that have adopted it as part of their examination requirements.

Pros

• Because the enhanced EPPP includes assessment of both knowledge and skills, it provides legitimacy to the public, payors, and interdisciplinary systems for the profession of psychology.
• Unlike other forms of testing, certification tests like the enhanced EPPP are for the express purpose of protecting the public from those who lack the judgment and skill to perform their job safely. The focus of the enhanced EPPP is to protect the public. 
• The enhanced EPPP is a particularly well-developed and managed testing program that meets or exceeds all professional standards that it is obliged to meet.
• The validity of the enhanced EPPP is established in the very first activity in the development of the exam—the Practice Analysis.
• Like all reputable certification tests, the ASPPB began its development process for the enhanced EPPP by assembling panels of practicing psychologists who spend years establishing the content outline of the prospective exam.
• As in the development of certification tests, development of the EPPP-Step 2 included peer review committees who performed comprehensive surveys of employers and practitioners, asking them exactly what the essential requirements of being a psychologist are.
• To remove the enhanced EPPP as a licensure requirement weakens the ability of psychology licensure agencies to protect the public. The burdens placed upon psychological practitioners to earn licensure must be considered in the context of the public’s right to know that their psychologists are safe.

Cons

• Cost is one of the greatest burdens of the test as early career psychologists (ECPs), and students have limited resources. The enhanced EPPP will add an additional and burdensome expense to ECPs who are already facing financial hardship due to the existing student loan crisis. An additional test will come with both the cost of the test itself as well as the likely burden of test preparation materials.
• Indirect costs associated with a second exam include lost productivity, lost income, and increased debt due to the additional time required to prepare for the two-part exam.
• The timing of the exam may be a concern if students are permitted to take the EPPP-Step 1 prior to graduating. Concerns include: (1) whether the process for how schools  approve a student’s eligibility to sit for the exam will be standardized across jurisdictions, (2) whether the EPPP-Step 1 scores will be used as a measure for internship readiness, and (3) whether the exam scores will be used in disciplinary dealings as a measure of success or failure. 
• Concerns have been raised regarding the validity of the exam after publication of a recent study of exam scores in the state of New York suggesting there might be different pass-rates among demographic groups on EPPP-Step 1 (Macura & Ameen, 2020; Sharpless 2019; Sharpless 2019). 
• Adding additional steps to licensure may further delay entry into practice.
• ASPPB (2020) has stated that already-licensed psychologists will not be required to take EPPP-Step 2; therefore, this places an undue burden on early career psychologists in comparison with already licensed individuals. 
• Additional barriers to licensure may negatively impact the number of individuals aspiring to be psychologists. As individuals seek a career in serving the public’s mental health needs, excessive regulations and hurdles may deter individuals from choosing a career as a psychologist. Psychology may lose highly qualified students to other professions.
• Some have argued that there is not enough information on the EPPP-Step 2 validity and ability to predict psychologists’ competent care or risk to safety to the public (Callahan et al., 2020).

Debates

(The counterpoint positions presented here are arguments that Robin McLeod is developing in a longer article that is in progress.)

Validity

Point

ASPPB thus far has failed to address many standard facets of validity including structural validity and stability across subgroups (Callahan, et al, 2020). ASPPB thus far has relied exclusively on unpublished research that has not been subjected to peer review and lacks evidence of external validity. Adoption of a poorly validated and vetted test is in direct conflict with the Standards for Educational and Psychological Testing (2014) jointly developed by the American Educational Research Association (AERA), American Psychological Association (APA), and National Council on Measurement in Education (NCME), as well as the APA Ethical Principles of Psychologists and Code of Conduct.

Counterpoint

The EPPP-Step 2 meets AERA, APA, and NCME Standards of Testing (2014). The recent published criticisms of the EPPP (Callahan, et al, 2020) stem from a misunderstanding of which standards govern certification tests. A certification test includes licensure exams which are mandated by state, provincial, and territorial (SPTA) jurisdictions in the practice of psychology. The proper standards to hold the EPPP against are in Chapter 11 of the AERA Standards (2014), which concerns certification testing specifically. Several important points are identified in the AERA Standards: 

• There is no expectation that a certification test demonstrate predictive validity because the purpose of certification tests is “to ensure that those who are licensed possess knowledge and skills in sufficient degree to perform important occupational activities safely and effectively (AERA, 2014, p. 174).
• There is no expectation that a certification test must demonstrate construct or structural or factorial validity as many have suggested. “Validation of credentialing tests depends mainly on content-related evidence” (AERA, 2014, p. 175). Further, the EPPP is developed using an IRT Rasch psychometric model, as many credentialing tests are. Since this is not a multidimensional IRT model, there is literally no expectation of complex structure. A Rasch model presumes a single quantitative dimension.
• In addition, the notion that a certification test is primarily founded on content validation suggests that critics are misguided who suggest that peer review is somehow lacking in the EPPP. On the contrary, the validation of a certification test takes place under what is probably the most peer-reviewed process in all of testing called a Job Task Analysis. 

Diversity

Point

For many years, the profession of psychology has valued diversity within the field and in the general public. There are already documented concerns (Macura & Ameen, 2020; Sharpless 2019; Sharpless 2019) for problematic differential validity of the current EPPP-Step 1 and a potential problem for the EPPP-Step 2. Addition of the EPPP-Step 2 without evidence of validity across diverse populations could further negatively restrict the diversity of individuals entering professional psychology, thus reducing access to care, particularly access to culturally competent care.

Counterpoint

The makers of the EPPP-Step 2 are working to address diversity issues in item development. Until the test is implemented, claims cannot be made that the test discriminates against different groups. The research question will be whether there are differential outcomes, and ASPPB has communicated a commitment to conduct such research.

Gatekeeping

Point

The mission of ASPPB, and in turn the creation and management of the enhanced EPPP, is to “support U.S. and Canadian psychology licensing boards in meeting their mandate of public protection (ASPPB, 2020).” However, there is no demonstrated crisis in the profession of psychology to need an additional test beyond the existing EPPP. Licensure board complaints are rare (ASPPB, 2019), and it is even more so for complaints to be made against the early career psychologists who are subject to the test.

Counterpoint

Licensure exams do not predict public harm. Licensure complaints are made against those who have passed the licensure exam. Further, it is true that there is not a demonstrated crisis in the profession of psychology; however, there is a crisis in the legitimacy of examinations in protecting the public. That crisis is addressed by the EPPP-Step 2. The lack of assessment of competency of licensees weakens the ability of psychology licensure agencies to protect the public. The burdens placed upon psychological practitioners to achieve licensure must be considered in the context of the public’s right to know that their psychologists are safe. 

Future directions

There are reasons to revise, or even retire, the previous EPPP to make way for an improved, single test of competence rather than requiring an additional exam for examinees. If EPPP-Step 1 is retained, timing of when the exam is to be taken should be shifted to pre-graduation. EPPP-Step 1 could be given pre-degree or immediately following coursework. This can reduce costs of study materials. However, state licensing boards would need to approve this move. 

• If EPPP-Step 1 is moved to pre-degree, there will be additional peer support and loan money to cover costs. This would also mirror medical students’ exam process.
• Moving the EPPP-Step 1 to pre-degree can help as a gatekeeping mechanism. 
• Moving EPPP-Step 1 to pre-degree may put additional responsibility on training programs to prepare students to pass.
• Moving EPPP-Step 1 to pre-degree may increase pass rates by linking the test closer to classroom work.
• ASPPB and outside entities should study differential outcomes for diverse psychologists through a peer review process.
• ASPPB and outside entities should continue to provide additional information on validity as test is implemented.

Resources

Stringer, H. (2016, July/August). A new licensure test is on the horizon. What is it and why is it necessary? Monitor on Psychology. https://www.apa.org/monitor/2016/07-08/licensure-test

Bradshaw, J. (2020). ASPPB rolls out EPPP-2 – names ‘early adopters’. National Psychologist. https://nationalpsychologist.com/2020/02/asppb-rolls-out-eppp-2-names-early-adopters/106954.htmlopens in new window

Karr, J., Bailey, T. (2018, May 8). APA Responds to ASPPB about the EPPP Part 2 Exam? gradPSYCH Blog. https://www.gradpsychblog.org/apa-responds-to-asppb-about-the-eppp-part-2-exam/#.XqrldS2ZPpAopens in new window

Association of State and Provincial Psychology Boards (ASPPB) (2020). The Examination for Professional Practice in Psychology (EPPP): Frequently asked questions. https://cdn.ymaws.com/www.asppb.net/resource/resmgr/eppp_2/eppp_part_2-skills_faq_s_1.pdf

Association of State and Provincial Psychology Boards. (2019). ASPPB disciplinary data system: Historical disciplinary report. cdn.ymaws.com www.asppb.net/resource/resmgr/dds/dds_historical_report_2019.pdfopens in new window

American Educational Research Association, American Psychological Association, National Council on Measurement in Education., & Joint Committee on Standards for Educational and Psychological Testing (U.S.). (2014). Standards for educational and psychological testing. Washington, DC: American Educational Research Association.

Callahan, J. L., Bell, D. J., Davila, J., Johnson, S. L., Strauman, T. J., & Yee, C. M. (2020). The Enhanced Examination for Professional Practice in Psychology: A viable approach? American Psychologist, 75(1), 52–65. https://doi-org.xxproxy.smumn.edu/10.1037/amp0000586opens in new window

Macura, Z., & Ameen, E. J. (2020, April 9). Factors associated with passing the EPPP on first attempt: Findings from a mixed methods survey of recent test takers. Training and Education in Professional Psychology. Advance online publication. https://dx.doi.org/10.1037/tep0000316opens in new window

Sharpless, B. A. (2019) Are demographic variables associated with performance on the Examination for Professional Practice in Psychology (EPPP)?, The Journal of Psychology, 153:2, 161-172, DOI: 10.1080/00223980.2018.1504739

Sharpless, B. A. (2019, December 12). Pass rates on the Examination for Professional Practice in Psychology (EPPP) according to demographic variables: A partial replication. Training and Education in Professional Psychology. Advance online publication. https://dx.doi.org/10.1037/tep0000301opens in new window