Saturday, April 9, 2011

Board Certification: What Does it Mean?

Professional certification involves being able to competently complete a job or task, usually demonstrated by the passing an examination after specified educational experience.  In first-party certification, an individual or organization, such as a training facility providing the service offers assurance that it meets certain claims. In second-party certification, an association to which the individual or organization belongs provides the assurance.  Third-party certification involves an independent assessment declaring that specified requirements pertaining to a product, person, process or management system have been met.  In medicine and psychology, second party certification is conducted by national bodies or organizations, such as a professional society.  Third party certification is used in psychology licensure. Board Certification is common in medicine and less common in psychology.  Consider four examples:

Mary Smith*, MD has a certificate on her office wall that says she is a Board Certified Child Neurologist.  That means she has successfully completed four years of premedical education in an accredited college or university with a 3.86 grade point average, four years of medical school resulting in doctor of medicine degree, one year internship in internal medicine, 1 year of training in clinical adult Neurology, 1 year of training in the principles of neurophysiology, neuropathology, neuroradiology, neuroophthalmology, psychiatry, rehabilitation, neurological surgery, neurodevelopment, and the basic neurosciences and one year of training specifically in clinical Child Neurology.  She also completed a two-year fellowship in Neurodevelopmental Behavioral Pediatrics. Her total college and post-graduate training was 14 years.

Jane Roberts*, PhD, has a certificate on her office wall that says she is a Board Certified Clinical Psychologist.  She completed four years of undergraduate school at an accredited university majoring in psychology with a 3.8 grade point average, four years in an American Psychological Association Accredited doctoral training program.  In her last year she completed supervised clinical rotations in three settings, 20 hours per week in a child guidance clinic, an inpatient hospital unit for severely disturbed children and in a community residential program for youth with substance abuse problems. In each she was supervised by an experienced licensed psychologist. During her rotations she had practice doing interviewing, administering and interpreting examinations and some experience with therapy.  After completing her PhD, she devoted a year in an approved Association of Psychology Postdoctoral and Internship Centers program. She then passed the Examination for Practicing Professional Psychologists (EPPP) which is a national exam required of all licensed psychologist.  She worked as clinical psychologist for several years at a university hospital outpatient clinic, then applied for Board Certification as a Clinical Psychologist. The Association of Board Certified Professional Psychologist certification process included 1) Credentials Review, 2) Peer-reviewed Practice Samples and 3) Oral Examination conducted by board certified psychologists.  She completed all of these hurdles and is now a Board Certified Professional Psychologist.  Her total college and post-college training and practicum experience was 14 years.

Jan Green*, MA is also a Board Certified Behavior Analyst. She completed a four-year degree in education at an accredited state college, including one course in psychology, one in child development, courses in curriculum, educational inclusion and diversity, literacy and classroom management as well as completing the other liberal arts distribution requirements, with a 2.7 grade point average.  She enrolled in an on-line MA/BCBA course offered by an established brick and mortar state college.  She completed four on-line behavior analysis courses and one elective in Kinesiology. She worked in a public school special education classroom as a paraprofessional aide that included several students with autism.  The school psychologist for her district, who is a BCBA, supervised her practicum experience, which consisted of performing observational assessments concerning a child with ADHD, designing an intervention for one student with Asperger Disorder and conducting a functional behavioral assessment for another labeled emotionally disturbed. She passed the Behavior Analyst Certification Board examination and is now working for a private company as a BCBA consultant to other community agencies.  She has a total of four undergraduate years of college in elementary education plus four post-graduate courses on behavior analysis, and practicum experience with three students.

John Jones*, MS, has a certificate on his wall that says he is a Board Certified Behavior Analyst.  He completed two years in a community college enrolled in pre-business classes with passing grades, then transferred to a commercial on-line college where he studied to be a dietician. He had difficulty with some of the chemistry classes.  To pay his way through college he worked at a group home for adults with Intellectual Disabilities, two of whom had autism.  He became interested in autism, and enrolled in a commercial on-line university where he completed four required classes in behavior analysis and took an additional elective class in personnel practices, and was awarded a Masters Degree.  He purchased a BCBA exam preparation pack for $295 dollars and read Heron, Cooper and Heward’s textbook Applied Behavior Analysis. He continued working in the group home, and a certified BCBA who consulted for the group home “signed off” on his work at the group home as supervised behavior analysis experience while he assisted with several residents with behavior challenges.  He spent six weeks one summer volunteering for a summer camp for children with autism.  He passed the national examination offered by the Behavior Analysis Certification Board.  He is now is in private practice providing Early Intensive Behavior Intervention services to 2-7 year old children with autism and billing Medicaid and private insurance for his services. He has hired several high-school graduates to work for him conducting most of the hands-on intervention which he supervises. His total college and post-college training was 2 years at a community college, two years at a commercial on-line dietician’s college, and four on-line courses in behavior analysis.  Most of his supervised experience was with adults with developmental disabilities, not children with autism.

The meaning of Board Certification varies enormously with the specific field of specialization.  Fourteen years of in depth classwork in basic medical and clinical sciences, and years of supervised clinical training on differential diagnosis and a wide range of treatment strategies on one hand, versus two years of business class, two years of dietics classes and four 3-credit behavior analysis classes, and assisting with behavioral intervention clinical services to several adult clients with developmental disabilities, on the other. Even the person who graduated from a college of education had limited relevant coursework to prepare her for a master’s degree in applied behavior analysis. The two types of Board Certification are obviously worlds apart, meaning very different things.

Some Master’s Degree/BCBA programs in Behavior Analysis offered by recognized bricks-and-mortar universities are more demanding and involve closer, hands-on supervision by commendably experienced mentors, as in Jan Green’s case above.  Some integrate face to face with on-line instruction.  But there is nothing in the Behavior Analysis Certification Board requirements that mandates that adequate supervised experience is obtained. The amount of supervised experience received by many BCBA's appears to be minimal.

While Gertrude Stein may have been right that a rose is a rose is a rose, regrettably it isn’t the case that board certification is board certification is board certification.

[* While the names are fictitious the descriptions are representative of training experiences of varying types of board certified individuals.]

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