Who are all these people?
Reducing confusion about the various professionals who say they can treat your kid’s learning disorder
Every once in a while, a new family comes to my practice seeming to know very little about my professional credentials. Should they call me Ms. Davis? (My title is Doctor!) Do I prescribe medication? (No!) Most of the kids in my practice have wealthy, highly educated parents, so the lack of savvy here surprises me, and I imagine people with fewer socioeconomic advantages must be even more confused about what various mental health professionals can and cannot do for them.
I think practitioners, rather than consumers, are to blame for this confusion. Kids with neurodevelopmental disorders are referred to an overwhelming range of professionals offering overlapping services, leading to confusion, duplication, and variable quality of care.
The situation only becomes worse when different mental health professions jockey for expanded scopes of practice. School psychologists, for example, lobby to provide psychoeducational testing in private practices and community clinics, which goes beyond their traditional role within school settings. Meanwhile, psychologists push for prescription privileges, a function historically reserved for psychiatrists and other medical professionals with extensive pharmacology training. And psychiatrists wade into the realm of neuropsychological assessment and educational diagnostics, even though their training generally excludes these sorts of issues.
(Don’t get me started about various unlicensed and unregulated executive functioning coaches and educational therapists saying that they provide therapy.)
Maintaining clearly defined roles and boundaries is not just a matter of professional pride—it’s a matter of safeguarding quality care for consumers. That’s why state-operated Offices of the Professions regulate these titles so carefully. Each mental health discipline has distinct training requirements and areas of expertise. Allowing “scope creep” in mental health not only risks diluting the quality of care but also leads to consumer confusion. Clients seeking mental health treatment deserve to know what they’re getting when they choose to work with a particular type of practitioner.
Some argue that expanding the professional scope of certain roles will increase access to care, particularly in underserved areas where mental health treatment is scarce. But I think a more logical approach would be to reduce the regulatory barriers preventing licensed professionals from practicing across state lines. Teletherapy and telemedicine have allowed us to transcend geographical limitations. By focusing on loosening restrictions on interstate practice, we could allow qualified professionals to reach clients in treatment deserts without compromising professional standards or blurring the roles of different specialties.
To reduce confusion, here is a cheat sheet:
-Diagnosis of Neurodevelopmental Disorders: Licensed psychologists, neuropsychologists, psychiatrists, developmental pediatricians, neurologists, and psychiatric nurse practitioners with specific expertise in developmental conditions can diagnose neurodevelopmental disorders.
-Diagnosis of Psychopathology: Licensed psychologists, psychiatrists, neuropsychologists, and psychiatric nurse practitioners are qualified to diagnose a range of comorbid mental health conditions.
-Special Education Classification: School psychologists and related school professionals can provide formal special education classification within the educational system.
-Psychotherapy: Licensed mental health professionals, including social workers, psychologists, and psychiatrists, can provide psychotherapy.
-Related Behavioral Services: Behavioral interventions and support, not classified as psychotherapy, may be provided by professionals such as board-certified behavior analysts (BCBAs), occupational therapists, speech-language pathologists, and school counselors. These roles focus on targeted behavioral skills, social-emotional learning, and communication strategies.
-Medication Prescription and Management: Psychiatrists, neurologists, and developmental pediatricians are permitted to prescribe medications. Some other medical professionals, like psychiatric nurse practitioners and physician assistants, can also prescribe medications, usually under the supervision of a physician.
-Miscellaneous Professional Support: executive functioning coaches, parent coaches, and other non-licensed providers can offer general support, but these roles are not regulated, and they are not qualified to diagnose or treat mental health disorders.
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Couldn’t decide if I should post this or this, so you get both!