Iowa Admin. Code r. 653-19.2 - Standards of practice-supervision of a conditional prescribing psychologist
A supervising physician shall be a person who is licensed to practice medicine and surgery or osteopathic medicine in Iowa who regularly prescribes psychotropic medications for the treatment of mental disorders as part of the physician's normal course of practice and who supervises a conditional prescribing psychologist. A supervising physician shall be board-certified in family medicine, internal medicine, neurology, pediatrics, or psychiatry. A supervising physician shall fully comply with the following standards of practice:
(1)
Supervision. During supervised practice, a supervising
physician oversees a conditional prescribing psychologist to ensure patient
safety and optimal outcomes. This includes ensuring proper clinical
examinations, necessary testing, and appropriate psychopharmacology services
for the patient's condition. Supervision can occur in person or electronically
according to these rules.
(2)
Primary supervising physician. A supervising physician shall
determine whether the supervising physician has been designated as a
conditional prescribing psychologist's primary supervising physician and
fulfills the responsibilities of the primary supervising physician in
accordance with these rules. A conditional prescribing psychologist may have
more than one supervising physician.
(3)
Maximum number of conditional
prescribing psychologists. A supervising physician cannot supervise
more than two conditional prescribing psychologists at one time.
(4)
Minimum period of
supervision. The primary supervising physician shall ensure that a
conditional prescribing psychologist completes a minimum of two years of
supervised practice prescribing psychotropic medications to patients with
mental disorders in accordance with these rules in order for the conditional
prescribing psychologist to be eligible to apply for a prescription
certificate.
(5)
Minimum
number of patients. The primary supervising physician shall ensure
that a conditional prescribing psychologist has seen a minimum of 300 patients
who had a diagnosed mental disorder for whom pharmacological intervention was
considered as a treatment option, even if a decision was made not to prescribe
a psychotropic medication to the patient. The primary supervising physician
shall ensure that a conditional prescribing psychologist has treated a minimum
of 100 patients with psychotropic medication throughout the supervised practice
period.
(6)
Initial
assessment. Prior to supervising a conditional prescribing
psychologist, each supervising physician shall assess the conditional
prescribing psychologist's relevant education, training, experience, and
competence.
(7)
Scope of
practice. Each supervising physician shall ensure that all
psychopharmacology services provided by a conditional prescribing psychologist
are within the competence and scope of practice of the supervising physician
and the conditional prescribing psychologist.
(8)
Prescriptive authority.
Each supervising physician shall ensure that a conditional prescribing
psychologist only prescribes psychotropic medications for the treatment of
mental disorders.
(9)
Prescriptions. A supervising physician shall ensure that each
prescription issued by a conditional prescribing psychologist identifies the
prescriber as a "psychologist certified to prescribe" and includes the Iowa
license number of the conditional prescribing psychologist and the name of the
supervising physician.
(10)
Active DEA and CSA registration. A supervising physician shall
ensure that a conditional prescribing psychologist has an active DEA
registration and CSA registration at all times during the period of
supervision.
(11)
Patient
populations. A supervising physician shall ensure that a conditional
prescribing psychologist only provides psychopharmacology services to patient
populations within the conditional prescribing psychologist's education,
training, experience, and competence. A supervising physician may establish
limitations on the types of populations to whom a conditional prescribing
psychologist may provide psychopharmacology services based on the conditional
prescribing psychologist's education, training, experience, and
competence.
(12)
Psychotropic medications. A supervising physician shall ensure
that a conditional prescribing psychologist only prescribes psychotropic
medications that are within the conditional prescribing psychologist's
education, training, experience, and competence. A supervising physician may
establish limitations on the types of psychotropic medications that a
conditional prescribing psychologist may prescribe based on the conditional
prescribing psychologist's education, training, experience, and
competence.
(13)
Specialization. A supervising physician shall ensure that a
conditional prescribing psychologist has completed the following training
during the supervised practice period to be eligible to prescribe psychotropic
medications to the respective population as a prescribing psychologist:
a.
Children. To prescribe to
patients who are less than 17 years of age, a conditional prescribing
psychologist shall complete at least one year of the required two years of
supervised practice in either:
(1) A pediatric
practice,
(2) A child and
adolescent practice, or
(3) A
general practice provided the conditional prescribing psychologist treats a
minimum of 50 patients who are less than 17 years of age.
b.
Elderly patients. To
prescribe to patients who are over 65 years of age, a conditional prescribing
psychologist shall complete at least one year of the required two years of
supervised practice in either:
(1) A geriatric
practice, or
(2) A general practice
with patients across the lifespan including patients who are over 65 years of
age.
c.
Serious
medical conditions. To prescribe to patients with serious medical
conditions, including but not limited to heart disease, cancer, stroke,
seizures, or comorbid psychological conditions, or patients with developmental
disabilities and intellectual disabilities, a supervising physician shall
ensure that a conditional prescribing psychologist has completed at least one
year prescribing psychotropic medications to patients with serious medical
conditions if the conditional prescribing psychologist intends to treat
patients with serious medical conditions after the supervised practice
period.
(14)
Informed consent. A supervising physician shall ensure that a
conditional prescribing psychologist obtains appropriate informed consent
before the conditional prescribing psychologist provides psychopharmacology
services to a patient.
(15)
Release of information. A supervising physician shall ensure
that a conditional prescribing psychologist obtains a release of information
authorizing the conditional prescribing psychologist to share information with
the supervising physician before the conditional prescribing psychologist
provides psychopharmacology services to a patient.
(16)
Primary care physician.
A supervising physician shall ensure that each patient has a designated primary
care physician before a conditional prescribing psychologist provides
psychopharmacology services to a patient. A supervising physician shall ensure
that a conditional prescribing psychologist maintains a cooperative
relationship with the primary care physician who oversees a patient's general
medical care to ensure that necessary medical examinations are conducted, the
psychotropic medication is appropriate for the patient's medical condition, and
significant changes in the patient's medical or psychological condition are
discussed. A supervising physician shall ensure that a conditional prescribing
psychologist engages in appropriate consultation with a patient's designated
primary care physician while the conditional prescribing psychologist is
providing psychopharmacology services to a patient.
(17)
Chart reviews. A
supervising physician shall personally review a representative sample of the
conditional prescribing psychologist's patient charts.
(18)
Performance
evaluations. A supervising physician shall regularly evaluate the
clinical judgment, skills and performance of a conditional prescribing
psychologist to safely provide psychopharmacology services to patients and
provide appropriate feedback to the conditional prescribing
psychologist.
(19)
Supervision plan. Before supervising a conditional prescribing
psychologist, a supervising physician must ensure there is an approved written
supervision plan. This plan should outline the supervisory relationship,
including review parameters, and consider both parties' education, training,
and experience and the psychopharmacology services involved. A template is
available from the boards of medicine and psychology. Both the supervising
physician and the psychologist must keep a copy of the plan and provide it to
the boards if requested. The supervision plan shall include the following:
a.
Conditional prescribing
psychologist's information. The name, license number, address,
telephone number, and email address of the conditional prescribing
psychologist.
b.
Supervising physician's information. The name, license number,
DEA registration number, CSA registration number, address, telephone number,
email address, and practice locations of the supervising physician.
c.
Designation of the primary
supervising physician. Designation of the conditional prescribing
psychologist's primary supervising physician.
d.
Period of supervision.
The beginning date of the supervision plan and estimated date of
completion.
e.
Locations
and settings. A description of the locations and settings where and
with whom supervision will occur.
f.
Scope of practice. A
description of the scope of practice of the supervising physician and the
conditional prescribing psychologist.
g.
Methods of communication.
A description of how the supervising physician and conditional psychologist may
communicate for appropriate supervision.
h.
Initial assessment. A
description of the steps the supervising physician has taken to assess a
conditional prescribing psychologist's relevant education, training,
experience, and competence prior to supervising the conditional prescribing
psychologist.
i.
Limitations on psychotropic medications. A description of any
limitations on the types of psychotropic medications the conditional
prescribing psychologist may prescribe consistent with the supervising
physician's and prescribing psychologist's relevant education, training,
experience, and competence.
j.
Limitations on patient populations. A description of any
limitations on the types of populations the conditional prescribing
psychologist may treat with psychotropic medications consistent with the
supervising physician's and prescribing psychologist's relevant education,
training, experience, and competence.
k.
Expectations and
responsibilities. A description of the expectations and
responsibilities of the supervisory relationship.
l.
Specialization. A
description of the specialized training to be completed by the conditional
prescribing psychologist in order to provide psychopharmacology services to
children (less than 17 years of age), elderly persons (over 65 years of age),
or patients with serious medical conditions, including but not limited to heart
disease, cancer, stroke, seizures, or comorbid psychological conditions, or
patients with developmental disabilities and intellectual disabilities in
accordance with rule 481-883.4(148,154B).
m.
Chart reviews. A
description of the steps the supervising physician has taken to personally
review a representative sample of the conditional prescribing psychologist's
patient charts.
n.
Consultation between the supervising physician and the primary care
physician. A requirement that the supervising physician consult with
the patient's primary care physician on a regular basis regarding the patient's
psychotropic treatment plan and any potential complications.
o.
Performance evaluations.
A description of the steps the supervising physician has taken to regularly
evaluate the clinical judgment, skills and performance of a conditional
prescribing psychologist to safely provide psychopharmacology services to
patients and provide appropriate feedback to the conditional prescribing
psychologist.
p.
Termination of the supervision plan. A description of how the
supervision plan may be terminated and the process for notifying affected
patients.
q.
Signatures. Signatures of the conditional prescribing
psychologist and all supervising physicians.
r.
Amendment to the supervision
plan. A requirement that a conditional prescribing psychologist shall
inform the board of psychology of any amendments to the supervision plan,
including the addition of any supervising physicians, within 30 days of the
change and that any amendment to a supervisory plan be subject to approval of
the board of psychology.
s.
Request for extension. If the primary supervising physician
determines that a conditional prescribing psychologist is unable to
successfully complete the supervised practice prior to the expiration of the
conditional prescription certificate, the conditional prescribing psychologist
may request an extension of the conditional prescription certificate provided
that the conditional prescribing psychologist and the primary supervising
physician can demonstrate that the conditional prescribing psychologist is
likely to successfully complete the supervised practice within the extended
time requested.
(20)
Certification of completion. At the conclusion of the
supervised practice period, the primary supervising physician shall certify the
following:
a.
Supervision.
That each supervising physician has provided supervision to the conditional
prescribing psychologist in accordance with these rules.
b.
Minimum period of supervised
practice. That the conditional prescribing psychologist has
successfully completed a minimum of two years of supervised practice.
c.
Minimum number of
patients. That the conditional prescribing psychologist has seen a
minimum of 300 patients who had a diagnosed mental disorder with whom
pharmacological intervention was considered as a treatment option, even if a
decision was made not to prescribe a psychotropic medication to the patient,
and that the conditional prescribing psychologist has treated a minimum of 100
patients with psychotropic medication throughout the supervised practice
period.
d.
Specialization. That a conditional prescribing psychologist who
intends to provide psychopharmacology services to children (less than 17 years
of age), elderly persons (over 65 years of age), or patients with serious
medical conditions, including but not limited to heart disease, cancer, stroke,
seizures, or comorbid psychological conditions, or patients with developmental
disabilities and intellectual disabilities, has successfully completed a
minimum of one year of supervised practice with the respective populations
during the supervised practice period.
e.
Demonstrated competence.
That a conditional prescribing psychologist has successfully completed the
supervised practice period and demonstrated competence in psychopharmacology by
demonstrating competency in the milestones sufficient to obtain a prescription
certificate in accordance with 481-subrule 883.3(2).
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
An
(1) Degree. An applicant shall possess a postdoctoral master of science degree in clinical psychopharmacology from a program designated by the APA as a program for the psychopharmacology training of postdoctoral psychologists. The degree program must be a minimum of 30 credit hours not including the practicum and shall include coursework in basic science, neuroscience, clinical medicine, pathological basis of disease, clinical pharmacology, psychopharmacology, and professional, ethical and legal issues. A minimum of one-third of the coursework must be completed in a live interactive format. The date the degree is conferred must be within the five-year period immediately preceding the application for a conditional prescription certificate . A program must be designated by the APA at the time the degree is conferred.
(2) Clinical experience. An applicant shall have completed a clinical experience in accordance with the requirements of this subrule. During the clinical experience, a psychologist shall learn clinical assessment techniques and pathophysiology through direct observation and hands-on training with a training physician . During the clinical experience, a psychologist shall become competent in health history interviews, physical examinations, and neurological examinations with a medically diverse patient population. The clinical experience must be associated with the psychopharmacology training program from which the psychologist obtained the postdoctoral master of science degree in clinical psychopharmacology.
a. Scope. At the beginning of the clinical experience, the psychologist shall directly observe the training physician performing clinical assessments of patients. After the training physician determines the psychologist has gained sufficient knowledge, the clinical experience shall transition to the psychologist 's performance of clinical assessments of patients under the direct observation of the training physician . After the training physician determines the psychologist has gained sufficient knowledge and experience, the psychologist may perform clinical assessments of patients without being directly observed by the training physician , provided that the training physician is on site at all times when the psychologist is with patients and is reviewing all medical records. A psychologist and a training physician shall have ongoing discussions regarding the psychologist 's clinical assessment skills and progress in the clinical experience.
b. Minimum experience. The clinical experience shall consist of a minimum of 600 patient encounters that shall be completed by the end of the practicum.
c. Conflict of interest. A training physician shall not be an employee of the psychologist or otherwise have a conflict of interest that could affect the training physician 's ability to impartially evaluate the psychologist 's performance. A psychologist may utilize more than one training physician .
d. Milestones. To satisfactorily complete the clinical experience, a psychologist shall demonstrate competency in each of the following:
(1) Perform a health history interview to obtain pertinent information regarding a patient's chief complaint, history of the present illness, past medical and surgical history, family history, allergies, medications, and psychosocial history. The psychologist shall perform a review of systems to elicit a health history and shall appropriately document the health history.
(2) Perform a physical examination in a logical sequence, ensuring appropriate positioning of the patient, proper patient draping, and proper application of the principles of asepsis throughout the examination. The psychologist shall verbalize and assess the components of a general survey and be able to accurately assess all of the following: vital signs, including pulse, respiration, and blood pressure; skin, hair and nails; head, face and neck; eyes; ears, nose, mouth and throat; thorax, lungs and axillae; heart; peripheral vascular system; abdomen; and musculoskeletal system. The psychologist shall be proficient in utilizing any equipment needed to conduct a physical examination.
(3) Complete a neurological examination demonstrating knowledge of the history related to the neurological system and the ability to assess the following: mental status, cranial nerves, motor system, sensory system, and reflexes. The psychologist shall differentiate normal laboratory values from abnormal laboratory values and correlate abnormal laboratory values with impaired physiological systems. The psychologist shall identify adverse drug reactions and identify laboratory data and physical signs indicating an adverse drug reaction.
e. Informed consent. At the initial contact, the psychologist shall inform the patient, or the patient's legal guardian when appropriate, of the psychologist 's training role in the clinical experience. The psychologist shall provide sufficient information regarding the expectations and requirements of the clinical experience to obtain informed consent and appropriate releases. Upon request, the psychologist shall provide additional information regarding the psychologist 's education, training, or experience.
f. Training documentation. The psychologist and the training director shall maintain documentation accounting for all clinical experience patient encounters, including the dates, times, and locations of all clinical experience patient encounters, and documentation of completion of the milestones defined in these rules. The applicant shall provide additional documentation to the board upon request.
g. Certification. The training physician (s) and the training director shall certify on forms provided by the board that the applicant has successfully completed the minimum number of clinical experience patient encounters required and demonstrated competence in clinical assessment techniques and pathophysiology through completion of the milestones defined in these rules.
(3) Practicum. An applicant shall have completed a practicum in accordance with the requirements of this subrule. During the practicum, a psychologist shall develop competencies in evaluating and treating patients with mental disorders through pharmacological intervention via observation and active participation. The practicum must be associated with the psychopharmacology training program from which the applicant obtained the postdoctoral master of science degree in clinical psychopharmacology and must be completed in a period of time not less than six months and not more than three years.
a. Scope. At the beginning of the practicum, the psychologist shall directly observe the training physician evaluating and treating patients with mental disorders. After the training physician determines the psychologist has gained sufficient knowledge, the practicum shall transition to the psychologist 's evaluation and treatment of patients under the direct observation of the training physician . After the training physician determines the psychologist has gained sufficient knowledge and experience, the psychologist may evaluate and treat patients without being directly observed by the training physician , provided that the training physician is on site at all times when the psychologist is with patients, has personal contact with the patient at each visit, and is reviewing all pertinent medical records. During the practicum, the training physician shall make all final treatment decisions, with consultation from the psychologist prior to making a final determination regarding the psychopharmacological treatment of a patient.
b. Minimum number of hours. A practicum shall consist of a minimum of 400 hours. Only hours spent face to face evaluating and treating patients with mental disorders and hours spent discussing treatment plans with a training physician may count as practicum hours. Time spent by the psychologist providing services that are within the scope of practice of a licensed psychologist , such as psychological examinations and psychotherapy, shall not be counted as practicum hours.
c. Minimum number of patients. A psychologist shall see a minimum of 100 individual patients throughout the practicum. A patient can be counted toward this requirement if the patient has a diagnosed mental disorder and pharmacological intervention is considered as a treatment option, even if a decision is made not to prescribe a psychotropic medication to the patient. Over the course of the practicum, the psychologist shall observe, evaluate, and treat patients encompassing a range of ages and a variety of psychiatric diagnoses.
d. Settings. At least 100 hours of the 400 hours must be completed in a psychiatric setting. At least 100 hours of the 400 hours must be completed in a primary care or community mental health setting.
e. Conflict of interest. A training physician shall not be an employee of the psychologist or otherwise have a conflict of interest that could affect the training physician 's ability to impartially evaluate the psychologist 's performance. A psychologist may utilize more than one training physician .
f. Milestones. To successfully complete the practicum, a psychologist shall demonstrate competency in each of the following:
(1) Physical examination and mental status examination. The psychologist shall perform comprehensive and focused physical examinations and mental status evaluations, demonstrate proper use of instruments, and recognize variation associated with developmental stages and diversity.
(2) Review of systems. The psychologist shall integrate information learned from patient reports, signs, symptoms, and a review of each major body system, recognizing normal developmental variations.
(3) Medical history interview. The psychologist shall systematically conduct a patient clinical interview, producing a patient's medical, surgical, psychiatric, and medication history, as well as a family medical and psychiatric history, and be able to communicate the findings in written and verbal form.
(4) Assessment indications and interpretation. The psychologist shall order and interpret appropriate tests (e.g., psychometric, laboratory, and radiological) for the purpose of making a differential diagnosis and monitoring therapeutic and adverse effects of treatment.
(5) Differential diagnosis. The psychologist shall determine primary and alternate diagnoses using established diagnostic criteria.
(6) Integrated treatment planning. The psychologist shall identify and select, using all available data, the most appropriate treatment alternatives, including medication, psychosocial, and combined treatments, and sequence treatment within the larger biopsychosocial context.
(7) Consultation and collaboration. The psychologist shall understand the parameters of the role of a prescribing psychologist and work with other professionals, including a patient's primary care physician , in an advisory or collaborative manner to effectively treat a patient.
(8) Treatment management. The psychologist shall apply, monitor, and modify as needed the treatment of a patient and learn to write valid and complete prescriptions.
(9) Medical documentation. The psychologist shall demonstrate appropriate medical documentation for the patient-psychologist interaction to include subjective and objective assessment; mental status, physical examination findings, or both; formulation; diagnostic impression; and comprehensive treatment plan.
g. Informed consent. At the initial contact, the psychologist shall inform the patient, or the patient's legal guardian when appropriate, of the psychologist 's training role in the practicum. The psychologist shall provide sufficient information regarding the expectations and requirements of the practicum to obtain informed consent and appropriate releases. Upon request, the psychologist shall provide additional information regarding the psychologist 's education, training, or experience.
h. Training documentation. The psychologist and the training director shall maintain documentation regarding all patients observed, evaluated, and treated by the psychologist as part of the practicum. The documentation shall clearly identify the training physician for each patient. The psychologist and the training director shall maintain documentation of all practicum hours, including the dates, times, and locations of all practicum hours, and documentation of completion of the milestones defined in these rules. The applicant shall provide additional documentation to the board upon request.
i. Certification. The training physician (s) and the training director shall certify on forms provided by the board that the psychologist has successfully completed the minimum number of practicum hours, treated the minimum number of patients, and demonstrated competence in the evaluation and treatment of patients with mental disorders through pharmacological intervention through completion of the milestones defined in these rules.
(4) Examination. A psychologist shall pass the Psychopharmacology Examination for Psychologists (PEP) administered by the APA Practice Organization's College of Professional Psychology or by the Association of State and Provincial Psychology Boards. The passing score utilized by the board shall be the passing score recommended by the test administrator. The examination score shall be sent directly from the testing service to the board .