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The state board that regulates psychologists in Nevada will no longer require applicants from programs accredited by the American Psychological Association to pass a controversial exam deemed by critics to be racially biased and scrapped by its creators. But applicants who did not attend an accredited program will still have to take the controversial exam to be licensed.
Nevada, perpetually ranked one of the worst states in the nation for mental health services, was the only state that required applicants, other than those licensed by another state, to pass the Examination for Professional Practice in Psychology Part 2 (EPPP-2). The EPPP-1, which is required to be passed by applicants in Nevada and other states, evaluates knowledge, while the EPPP-2 is designed to measure skills essential in the practice of psychology.
While not requiring applicants from accredited programs to take the test “is a great step, it also is not enough,” Dr. Bernadette Hinojos, a Las Vegas psychologist, said via email, adding most applicants from non-APA accredited programs are people of color or from lower socioeconomic backgrounds – the individuals critics say are most aggrieved by the test. “This requirement is gatekeeping diverse and underserved populations of people from becoming psychologists.”
Psychologists in America are not representative of the populations they serve.
In 2019, the American Psychological Association (APA) found about 83% of U.S. psychologists are white, down only slightly from 2009, when 85% were white. Hispanics make up 7% of psychologists, 4% are Asian, and 3% are Black.
To achieve racial parity with the state population they serve, 60% of practitioners would be white, 30% Latino, 11% Black, and 10% Asian, according to the U.S. Census Bureau.
Hinojos told the board at its February meeting the EPPP-2 requirement “exacerbates the underrepresentation of diverse psychologists, with psychologists of color and those identifying as LGBTQIA+ facing particularly steep hurdles.”
Mental health professionals, she said, “are experiencing heightened demand for services, especially among trans individuals seeking evaluations for gender-affirming surgeries. The barriers currently in place limit the number of providers able to meet these needs, thereby impacting the communities that rely on them the most.”
Nevada has 673 licensed psychologists, according to the Nevada Board of Psychological Examiners (NBOP). It’s unknown how many are employed full-time.
Racial diversity among clinicians “is absolutely a barrier” to treatment in urban areas such as Las Vegas and Reno, Dr. Christopher Shewbarran, president of the Nevada Psychological Association, told the Current in February.
“Typically, folks are going to be more likely to seek out a provider” with whom they identify, he said.
Plans to expand the EPPP-2 to other states in 2026 were sidelined last year by the Association of State and Provincial Psychology Boards (ASPPB), the national organization that developed the exam, after Texas regulators led the fight to eliminate the test, alleging it was racially biased and costly.
Last month, Dr Hao Song, Associate Executive Officer of Examination Services of the ASPPB, told the Nevada Board of Psychological Examiners (NBOP), which regulates psychologists,that completion of a program accredited by the APA may mitigate any connection between demographics, socioeconomic factors, and performance on the EPPP tests.
“We did see that kind of, sometimes people from marginalized groups are more likely to be from non-accredited programs,” Song said, but acknowledged the observations “are more rumor. It’s not based on the data.”
Applicants may disclose personal information when taking the test, but it’s not required, she said, resulting in a lack of “clean data.”
Dr. Robert Moering, a member of NBOP, suggested Nevada could eliminate the requirement for a skills-based exam. Moering observed that most states don’t require one, adding psychologists “have chosen to get their exams in other states simply because it was much easier to get that license without having to take the EPPP-2 or other types of skill-based exams.”
Dr. Stephanie Woodard, also a board member, warned of “unintended consequences” and potential legal liability, should the state choose to not require a skills-based test. “If that is the direction, in fact, that the board wants to go, I do think that we need some deliberation as a board on what the potential consequences of that could be.”
At that point, the board went into closed session to hear from legal counsel Harry Ward of the Attorney General’s Office.
The board subsequently voted unanimously to require the EPPP-2 only for applicants who did not attend APA-accredited programs and were not licensed in another state prior to Nov. 1, 2020.
The board also voted to research the feasibility and cost of updating the state’s competency exam, which was required before the EPPP-2, and included a few skills-based questions.
“We really need to have an appreciation for what the cost will be for reinstating the old exam in the various possible formats that we discussed,” Dr. Lorraine Benuto, the board president said, echoing other members’ concerns about cost.
The board is supported solely by licensing fees, noted Dr. Sheila Young, who warned updating the test could cost $30,000 to $50,000, and may be used only briefly until the ASPPB issues a hybrid test expected in 2027.
Noting “Nevada has been struggling to meet mental health demands and provide support in many areas, and that all counties in Nevada are experiencing a mental health shortage, the Nevada Psychological Association supports” eliminating the EPPP-2 for providers who attended an accredited program.
Shewbarran added the NPA hopes the board reconsiders continuing to require the test of those who didn’t attend an accredited program, noting there was a process for those psychologists “to apply for licensure prior to the implementation of the EPPP-2.”
Money grab?
Individual board members did not respond to the Current’s inquiry about why they would require some applicants to pass a test that has been shelved by its creator.
“EPPP-2 is unnecessary and invalid,” Las Vegan Donald Cloud, who submitted public comment to the board, said via email to the Current, adding the APA Code of Ethics renders an outdated test as obsolete. “It may be available to use but the results are of little value. EPPP-2 is not valid – it does not actually measure competence.”
Cloud says APA-approved programs prepare applicants to pass EPPP-1. He says non-accredited programs “are not any less expensive. Sometimes they are more expensive. They just don’t teach the foundations adequately which is why people have a hard time passing EPPP-1 if they did not go to an APA-approved program. EPPP-2 is unnecessary. It’s just a money grab for ASPPB.”
Hinojos, in public comment, said study materials for the EPPP-2 are “notably limited” with only two resources – a set of videos from a private psychologist costing $175, or a 3-month subscription for an online program from ASPPB priced at $329 or $399 for a six-month subscription.
With only Nevada maintaining a requirement for the EPPP-2, “the likelihood of increased availability and accessibility of study materials appears minimal,” Hinojos said, adding the lack of study materials can result in applicants taking the test multiple times.
“This can result in thousands of dollars spent and lost,” she said.
The ASPPB did not respond to the Current’s request for comment.
Hinojos noted the Psychology Interjurisdictional Compact (PSYPACT), an organization dedicated to reducing obstacles to licensing, has 42 participating states with reciprocal licensing agreements, including Nevada. PSYPACT does not require the EPPP-2.
However, Woodard of the NBOP added, PSYPACT participants must attend an APA-accredited program.