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a reserved for those who do not provide mental health services, or those who are in training. We retained two categories of licensure for psychologists and social workers in our analyses because many states license mental health providers in these professions at two levels, representing different degrees of education and/or training.

In addition to the functional data that we collected for each profession, we used the state laws to gather information on the educational and supervised practice requirements for each type of license studied. In most cases, either the statutes or the rules for a profession specify how many hours of supervision must be completed, who is qualified to serve as supervisor, and what portion of the supervision must be “face-to-face” (as opposed to via telephone, email, or other indirect means). Our summary of education and training requirements includes observations on the extent to which these requirements may have positive or negative effects on the ability of newly trained members of a profession to practice in rural areas.

Because licensing standards for some professions have been implemented or changed in recent years, it is common for there to be some accommodation in educational standards in these statutes for practitioners who were practicing in the profession before the requirements became effective. This practice is known as “grandfathering” or “grandparenting.” Because there is tremendous variability in how states implement this practice, we chose not to catalogue variations due to grandparenting. What remains of the grandparented profession is exemplified by the status of master’s level psychologists who, in most states, do not have independent practice privileges, and are, in many states, in a transitional profession, on their way to going back to school to get a Ph.D. Table 1 presents the two levels of licensure, corresponding to Ph.D. and master’s prepared practitioners. (See also, “Training and Supervision Prior to Licensure” on p. 9)


In this section we present a brief description of the definitions used to guide our data collection efforts, in an attempt to assure inter-rater reliability across states, professions and statutes.

  • Assessment: In general, the term “assessment” applies to those practitioners who are legally

permitted to collect information and identify and categorize the patient/client’s illness or

a For example, school psychologists, psychological examiners, and provisional licenses to professionals in training, (for example, a “professional counselor associate” in some states has completed all licensure requirements except the supervised clinical practice).


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