Scopes of practice delineate the specific services and functions a health provider is permitted to perform. Ideally, SOPs should be fairly consistent for a given occupation across states, and complementary across behavioral health-related occupations so that a full range of behavioral health care services are authorized. Importantly, as demand for greater and more diverse behavioral health care services increases, expansion of occupational SOPs has been suggested as one mechanism for addressing issues related to worker shortage and its potentially negative impact on delivery of care.
This study collected SOPs from all 50 states for 9 behavioral health professions. In some cases, legal SOPs did exist for a given occupation in all states, in which case, professional scopes of practice established through mechanisms such as worker certification were analyzed. The purpose of the project was to compare behavioral health occupational SOPs across states and among occupations for similarities and gaps and assess whether elements should be added to a state or occupation SOP.
Findings
Scopes of practice (SOPs) define which services a state or territory allows a licensed or certified professional to perform. These essential constructs can vary by state, potentially leading to service coverage gaps on a national scale. The same statutes and administrative rules that contain SOP information also include other vital licensing information, such as educational and experience requirements.
The Behavioral Health Workforce Research Center collected SOPs for ten behavioral health occupations from all 50 states and Washington D.C. by extracting information from online statutes and administrative rules into a personal database. The purpose of the study was to: 1) create a database to serve as an updateable index of online statues and administrative codes for the nation’s behavioral health workforce; and 2) summarize descriptive information about behavioral health licensing, certification, and regulation across the country for multiple occupations.
Variables were grouped into three main categories, including regulatory information, licensure and certification requirements, and authorized services. These data were then analyzed for descriptive trends.
The results of this study showed that SOPs lack standardization across states and professions nationally. There is a great deal of variation in the detail provided in state SOPs. Peer and paraprofessionals, in particular, could use more formal SOPs, as many states have not codified the parameters of service authority or regulatory requirements for these professionals. Telehealth was notably absent from SOP language in many cases, although Medicaid reimburses for this service in nearly every state.
Overall, more uniform definitions and requirements in SOPs would promote standardization and could aid reciprocity and endorsement procedures across states. Future research should look at SOP variability across states and professions and determine whether enhanced SOPs are associated with better access to care and health outcomes for those with behavioral health conditions.
