The Psychological Clinical Science Accreditation System (PCSAS) seeks to integrate the science and practice of clinical psychology by identifying PhD programs that provide graduates with rigorous training in the evidence-based treatment of mental health conditions. PCSAS also supports ongoing research on clinical psychology and the dissemination of new findings to mental health care practitioners.
Since it was established in 2007, PCSAS has accredited 44 programs in the United States and Canada under the guidance of PCSAS Executive Director and APS Executive Director Emeritus Alan G. Kraut. In that time, PCSAS accreditation has been recognized in the licensing and staffing regulations for psychologists at the U.S. Department of Veterans Affairs and by the states of California, Delaware, Missouri, New Mexico, New York, Illinois, Michigan, and, most recently, Arizona.
Here, APS Fellow David A. Sbarra and William R. Corbin review their experience advocating for PCSAS accreditation in Arizona and offer advice for getting it on your university’s legislative agenda and working with lobbyists to build a better profession.
On April 14, 2021, Arizona Governor Doug Ducey signed into law H.B. 2561, which creates licensure parity for PCSAS and Council on Accreditation (COA) accreditation in the Arizona Revised Statutes (ARS). It took 5 years to change seven words in ARS! This is our story.
We have worked together collaboratively for the last 3 years. In the beginning (Years 1 and 2—or the Dark Ages, as we like to call it), Sbarra spent his time following some of the advice of our colleague, Tom Oltmanns, at Washington University: Get your university lobbyists and legislative affairs people involved as soon as possible.
Arizona codifies the licensing requirements in statute. Therefore, any changes require a legislative bill, and it is nearly impossible to have a bill introduced into the legislative agenda without a lobbyist helping the process, including identifying potential sponsors and discussing the best way to frame the issue. The team at Washington University had been highly successful in the Missouri parity campaign, and Sbarra set out to follow this basic strategy. The main problem getting off the ground: Nobody would return his calls.
We tried all kinds of brainstorming to get the attention of the vice president for government and community relations at the University of Arizona (UA) In consultation with the UA department head, Lee Ryan, and the PCSAS leadership, we identified a colleague who might have the political sway to kick things into action. Lynn Nadel is a regents professor of psychology at UA and was chair of the faculty in 2018. He was able to make a very strong case for the need for UA to be out in front on this, especially given the key roles of former UA professors Richard R. Bootzin and Varda Shoham in the formation of PCSAS.
Lesson #1: If you can’t get access to your legislative affairs colleagues, or your issue can’t get “elevated” enough to be on their radars, find a local influencer who can make this happen.
Whatever Lynn said worked, and the next fall, licensure parity found its way onto the formal Arizona Board of Regents (ABOR) legislative agenda. Given that this was an ABOR-sponsored activity, we (Sbarra and Corbin) joined forces to work collaboratively from then on. The key benefit of getting on ABOR’s agenda (that is, getting on your university’s legislative agenda) is that you get assigned a lobbyist. This is a person who knows the legislature and the legislative process inside and out, and this person is ready to help your cause succeed. Your legislative affairs colleagues work without pride or prejudice: They have a job and that is to get a win for the university.
We began with a few phone calls and in-person meetings to brief the legislative affairs folks on the initiative. The topics included teaching them about the accreditation landscape and the shortcomings of existing statutes. Our lobbyist colleagues were professional and meticulous, but they also operated on a need-to-know basis, and they repeatedly reminded us that we were making an argument to the legislators, not to each other. In other words, the reasons we think the legislation is important may not be the same as why legislators think it is important. For example, in Arizona, a compelling argument was open-market practices and competition. Having more than one recognized accrediting body creates competition that pushes both to be better. This is not a reason we would have come up with as academics, but it was an important message for legislators to hear.
Lesson #2: Once you’re formally pursuing legislative parity, keep your messaging as simple as possible.
If you’re deep enough into this issue to have read thus far, you’ll likely suffer from the “curse of knowledge” when explaining the issue to your lobbyists and legislators. Keep the messaging simple. This same principle applies to any changes to the licensing laws. In the second year that the bill was on the legislative agenda, we suggested changes to bring the statutes in line with current licensing practices (e.g., COA no longer requires individual graduate courses in breadth areas, but the statutes still use this language). This was a mistake on our part, because the state licensing board thought we were trying to tell them how the licensing statutes should be written, which they saw (rightfully so) as their job. We were trying to be helpful, but it was definitely not interpreted that way. So, don’t ask for more changes than you absolutely need. If you think broader changes are needed, work with relevant stakeholders on this process.
Lesson #3: Identify and engage your stakeholders.
In our first year with the lobbyists, we made a critical misstep: We didn’t engage all the local stakeholders. In Arizona, this meant getting support from our other ABOR university, Northern Arizona University (which did not have a clinical program at the time but now has a PsyD program); the Arizona Psychological Association (AzPA); the Board of Psychologist Examiners (aka the licensing board); and our students, who ultimately submitted a letter of support to the board on behalf of the initiative. In 2018, we failed to talk with the AzPA president from the get-go, so they basically sent their lobbyist out to subvert out efforts. We don’t blame them—we didn’t do our job of engaging with them well enough.
The engagement part of engaging your stakeholders is critical. Over the span of 3 years, Corbin attended many meetings with the licensing board in Phoenix, and Sbarra traveled from Tucson to meet with them on three occasions. Each time, we answered their questions as meticulously as possible. The board put up considerable opposition. As we discuss a bit below, engagement also means responsivity.
Lesson #4: It takes only one vocal opponent to derail the process.
As noted above, we had one vocal opponent on the licensing board, and he was able to prolong this process for several years. You might think that the majority rules in politics and legislation, but there are many steps in the legislative process, and one vocal opponent can shut things down—or at least slow them long enough to prevent the bill from going through. In our case, the vocal member of the licensing board was able to convince a key legislator that the bill was problematic, preventing the bill from getting through committee. The member of the licensing board was also able to mobilize the AzPA to oppose the bill. So, even though we likely had sufficient support at the level of the full committee and legislature, a single legislator was able to kill the bill. The take-home message is that it is critical to identify any vocal opponents and attempt to work with them to allay any concerns. A related point is that it is important to get the bill introduced as early as possible in the legislative session so that any efforts to slow the process do not result in the bill being pushed to the next year.
Lesson #5: Perseverance is key.
Sbarra joined the AzPA governing council in 2020 as their academic representative, and his platform statement centered on PCSAS licensing parity. All the while, Corbin kept returning to the board, presenting them with the same documents and often answering the same questions. Perseverance is key not just because it is important to “stick with it” in the euphemistic sense; rather, perseverance is key because the longer you stick around talking about something, the more people (a) believe it’s important, (b) see that you’re not a crank, and (c) start trusting that you have positive motivations. It’s equally important to be responsive. We didn’t just tell people about PCSAS; we tried to address their concerns.
For example, the board repeatedly complained about the PCSAS website. We shared this information with PCSAS, and the concerns ultimately led to more transparency and easier navigation of the website. With the PCSAS leadership, we helped rewrite some of the critical FAQs and talking points about the system. We believe these efforts were palpable.
In addition, for us, perseverance was about building bridges across legislative sessions. We worried very much that the lobbyists or ABOR would lose enthusiasm for the issue, so we tried to remain in their consciousness as much as possible. We would take a break for a few months when the session ended, but we always tried to keep the issue alive and discussions going about the next best steps: “What do we need to do to make this happen next year?” In the end, there was no one thing that made a difference for us. We experienced some bad luck along the way in early years—for example, we got stalled out in 2019 when legislators’ attention was drawn to the local instantiation of the Red for Ed movement. 2020 was, of course, all about COVID-19.
Lesson #6: Work with your lobbyists to understand the legislative strategy.
We were deeply engaged in trying to understand how a bill becomes a law in Arizona. We worked with the lobbyists in the early fall of each year to start thinking about the legislative session, who might be potential sponsor(s), and how any recent elections might have shaped the dynamics of power in our state. Your university’s lobbyist will or should run point on meeting with legislators and finding out who might sponsor your bill or change efforts. Still, you should be only one step behind, and you should work hard to keep the issue at the forefront of everyone’s minds without becoming annoying.
It’s critical to remain engaged with the lobbyists and to be a collaborator. We never fully turned the process over to them just because legislation was not our area of expertise; rather, we worked as collaborators throughout the process. Also remember, your issue is not the only issue the lobbyists are working on, so be patient and kind (but keep the ball moving forward).
Lesson #7: Have a theory of the case.
This is a variation on one of our earlier points. We experienced a major turning point in getting the board not just to remain neutral regarding our bill, but to make and support a motion in favor of parity! In fact, it was the very same person who actively opposed our initiative that ultimately became an ally. In our opinion, this worked because we offered him and rest of the board members a good theory of the case.
We pointed out that the burden of mental illness is only growing. Whereas specific areas of medicine have decreased both the incidence and prevalence of many diseases, clinical psychology has failed to do the same for mental illness. We suggested that this failure was a multidetermined problem but that one way forward may be to improve training innovations and to allow for a new system of well-trained psychologists. This proved a winning strategy with the board.
We offered legislators a different theory of the case. Following the advice of our colleagues in Missouri and the lobbyists, as noted above, we framed the licensure parity issue as one of market competition, which many legislators in Arizona care about quite deeply. There’s nothing insincere about this framing device, even if it’s unfamiliar to us as psychologists. We are not used to discussing a new accreditation system as market competition, but that is exactly what it is, and many business-oriented legislators could get behind this theory of the case.
We could go on, but this summarizes some of the main lessons learned. It was a long process in Arizona and a lot of work to change seven words in the statute. This brings us to our final lesson.
Lesson #8: Connect to something larger than your local pursuits.
What kept us going across 5 years was the desire to be part of this grassroots movement toward licensure parity. We are not the first state to create such parity, but we also considered the historical role Arizona has played in the founding of PCSAS and viewed our work as a critical brick in building the foundation of a better profession. It wasn’t always pretty, but when we faced setbacks, we tried to remember that we were part of something larger. This kept us going for half a decade, and we hope it will keep you going, too.