Limited prescription privileges for psychologists: Review and implications for the practice of psychology in the schools

Abstract

In this article, we present a balanced view of the prescriptive authority debate in relation to five major issues and within the context of the practice of psychology in the schools: (a) appropriate training, (b) quality of care, (c) access to services, (d) continuity of care, and (e) professional identity. We also provide an analysis of the quality and relevance of each issue within the school practice context. Despite the increasing momentum of the prescriptive authority initiative at the state level, it seems unlikely that prescription privileges will be extended to psychologists working in school-based practice settings. Nevertheless, informed school psychologists have the opportunity to become involved in this issue at both the national and state levels. These efforts may take the form of supporting or opposing the initiative or of lobbying for extension of prescriptive authority into some school settings. At the individual level, informed school psychologists will have the opportunity to develop strong working relationships with prescribing psychologists in their communities and to exercise appropriate professional judgments when referring students or families for services in the community. C 2009 Wiley Periodicals, Inc.The issue of limited prescriptive privileges for professional psychologists has been a longstanding topic of debate both within and outside the field for nearly two decades. The American Psychological Association (APA) strongly supports the lobby for prescription privileges, and has invested significant time and financial resources to support advocacy efforts at the national and the state levels. New Mexico and Louisiana have passed legislation allowing psychologists who meet stringent training requirements to obtain limited prescription privileges, and similar efforts are underway in several other states. The U.S. Department of Defense has also conducted trials to assess the feasibility of training professional psychologists to prescribe psychotropic medication in military health care settings.Nevertheless, the effort on the part of psychologists to obtain limited prescription privileges is staunchly opposed by some members of the medical community, particularly persons in the field of psychiatry. Moreover, there is no clear consensus within the profession of psychology that the pursuit of prescription privileges is an appropriate goal. A plethora of opinion studies has been conducted, most of which reveal varying of degrees of disagreement on this issue. In general, researchers have found that psychologists have more favorable attitudes toward the issue of limited prescription privileges than do psychiatrists, pediatricians, and other primary care providers (Rae, Jensen-Doss, Bowden, Mendoza, & Banda, 2007). Walters (2001) conducted a meta-analysis of the opinion data and reported that, overall, slightly more than half (52%) of surveyed psychologists supported the prescription initiative, with slightly more than one third (35%) expressing opposition. Other studies have also found that opin...

Future trends in the application and impact of psychopharmacology within the school setting

“…For review of this subject matter see the article by Ball, Kratochwill, Johnston, and Fruehling (2009). Although a relatively small number of professionals hold such privileges, as discussed by Roberts, Floress, and Ellis (2009) in their article, pharmacological consultation may be the arena in which the greatest impact of the role of psychological professionals may be seen.…”

Legal issues in school health services and school psychology: Guidelines for the administration of medication

“…(For information related to school psychologists' prescription privileges, the reader is referred to Ball, Kratochwill, Johnson, & Fruehling, 2009.) A number of lawsuits against schools have been found for the parents of children who were recommended psychoactive medication by school psychologists or other school personnel, and who suffered physical and/or psychological harm due to inappropriate medication suggestions [e.g., Benskin v. Taft City School District (1980);Valerie J. v. Derry CO-OP School District (1991)].…”

Academic journals can and should contribute to the future of school psychology.

“…For example, academic scholarship has been in the vanguard of eventual state policies that (a) recognize board-certified behavior analysis certification, (b) directly fund school-wide positive behavior intervention strategies, and (c) mandate the Response to Intervention framework in schools (Rentner et al, 2019; Whittaker & Burns, 2019), many of which fall within the domain of school psychologists (Sullivan & Long, 2010; Sullivan et al, 2011). To be sure, not all efforts have been successful; well-reasoned publications have advocated how prescription privileges would lead to a sea change in how psychology is practiced (McGrath & Sammons, 2011), including school psychology roles and functions (Ball et al, 2009). Whereas these efforts have resulted in intense state lobbying efforts, only five states currently permit independent prescribing authority to licensed psychologists (Robine et al, 2020).…”