APA adopts comprehensive record-keeping standards

By James Bradshaw and Richard Gill Staff Editors
January 1, 2007



Washington, D.C. – Two areas of importance to practicing psychologists were acted on at the February meeting of the APA’s Council of Representatives – how treatment records should be kept and a revision of the Model Act for State Licensure.

The council approved the revision of recommended record-keeping practices to bring standards in line with changes required by the expanded use of electronic records and changes in law, such as adoption of the Health Insurance Portability and Accountability Act (HIPPA).

In the licensure matter, the stage was set for likely adoption in August of a model act that among other things would specify that RxP training can be completed through approved professional schools.

RxP training has been the subject of hot debate since the National Register and the Association of State and Provincial Psychology Boards proposed last year that all such training should be achieved through accredited universities.

Stephen J. Lally, Ph.D., who served on the task force that reviewed practitioner records, said record-keeping prompts more questions to APA headquarters than any other topic.

“I think sometimes practitioners worry that ‘Oh, my God, I’m going to get in trouble for this,’ ” Lally said. He said the majority of cases shows that careful, extensive record-keeping can be the psychologist’s best evidence if treatment methods or ethics come into question.

The guidelines needed revision in part because of the level of detail being required by third-party payers, some health care contracts and principles of risk management, Lally said.

There is an entire new section on electronic record-keeping, he said. Lally emphasized that the guidelines are aspirational, not mandatory rules spelling out do’s-and-don’ts.

Concerning the model licensing act, the council approved without dissent an additional $10,000 for the task force reviewing the model to meet one more time. Ronald Fox, Ph.D., co-chair of the task force, said the approval was necessary to get the model act ready for adoption at the August APA convention to be held in San Francisco.

The task force has prepared a model that includes a model act for adoption of RxP legislation, along with a model curriculum for what an RxP training program should include. Asked if adoption of the model would eliminate the university affiliation requirement, Fox said, “That’s the intent.”

Russ Newman, Ph.D., J.D., executive director for professional practice, said the model act was long due for overhaul and covers changes in many areas other than RxP. For example, he said, the council last year approved eliminating the need for a year of post-doctoral supervision if two years of supervision could be achieved before completing doctoral work. That needed to be reflected in the model act, he said.

Other issues of importance included continuing work on a plan to give members of state and provincial psychological associations credit toward APA dues to encourage dual memberships, he said.

The council also approved having Norman Anderson, Ph.D., APA’s chief executive officer, oversee developing a continuing strategic planning process. Newman said it is important that matters of importance to practice are included in that planning.

A joint accreditation agreement for doctoral psychologists between the American Psychological Association and its Canadian counterpart, which began in 1984 with a memorandum of understanding, will be phased out over seven years.

Council members voted overwhelmingly to discontinue the agreement in which Canada borrowed heavily from APA standards, which led numbers of Canadians to train in the United States and then return to practice in their home country.

The resolution to end the mutual accreditation was backed by the Canadian Psychological Association (CPA), McGill University and Université Laval.

Speaking in favor of the proposal, Janel Gauthier, director of the school of psychology at Laval and secretary general of the International Association of Applied Psychology, used the analogy of early colonists wanting to break away from the British.

“There was no disrespect, but they wanted some independence.” He did not, he said, intend to carry the analogy to outright revolution. But, he added, “It is time to let the kid leave the house.”

Gauthier said the proposal would allow Canada to step out on its own, but he said the CPA would maintain a close relationship with the APA. Gauthier called the agreement “a bit demeaning.”

Robert D. McIlwraith, Ph.D., chair of the CPA accreditation panel, said currently about 10 students a year graduate from Canadian schools and return to practice in the United States. The phase-in will give students time to adjust to the change and allow the CPA and the APA to draft a new memorandum of understanding, he said.

In another matter, the council passed – over the objections of several members – a resolution to reject teaching intelligent design in science courses and reaffirmed support for teaching evolution. Dissenters contended the action could drive away potential clients because of their religious beliefs, but proponents countered that a belief in intelligent design could be taken into account in treatment and even could be taught in schools in such courses as comparative religion studies but should not be considered science.

At the request of a task force that began in July to study the effects of war on military personnel returning from combat deployments and their families, the council approved a $10,000 grant to further study the issue. Michelle Sherman, Ph.D., co-chair of the task force said the needs review showed great gaps in treatment, particularly for family members and reservists who do not live on military bases. Further work is needed to define how to address those needs, she said.

“It’s clear that they are facing psychological difficulties. There is no coordinated effort to help the families and returning service men and women,” Sherman said. What is needed, she said, is a centralized operation.

She stressed three steps to help families and service personnel: 1) A need for centralized leadership for the mental health care of families and returning combatants, 2) dedicated resources for the creation and execution of prevention and intervention programs and 3) a significant need for research to guide treatment of mental health problems created by deployment cycles for both returning military members and their families.

Sherman said a centralized effort has to start at the top with the Department of Defense, which also has a task force studying the issue.

In the financial report, APA’s finance officer, Jack McKay, said the association’s net worth, including property holdings, is conservatively estimated at $200 million. He said in the past nine years the investment portfolio, which now stands at $67 million dollars, has realized an average annual return of 14.56 percent.

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