The 20/20 Building Blocks to Portability Project
Building Blocks to Portability The task was to develop: A consensus licensure title to recommend to all state licensing boards A consensus scope of practice to recommend to all state licensing boards Consensus education requirements to recommend to all state licensing boards
The delegates reached consensus on the licensure title!
Some Key Elements Individual, group, couples, & family counseling Promote mental health wellness, development across the lifespan, crisis intervention and the diagnosis and treatment of mental disorders Consultation and program evaluation Supervision Ability to practice independently
TWO OUT OF THREE AIN’T BAD! What about the licensure education requirements?
Masters in Counseling Accreditation Council (MCAC)
Initial MCAC programs U of Albany (mental health counseling) U of Massachusetts, Boston (mental health counseling & school counseling)
THE COUNSELING PSYCHOLOGIST VOL. 41, NO. 5, JULY 2013 Psychology & counselor education accreditation
Articles Quality of Master’s Education: A Concern for Counseling Psychology? Looking to the Future – The role of Master’s Programs in Counseling Psychology Integrating Master’s Education in Counseling Psychology for Quality, Viability, and Value Added Legitimizing and Reclaiming Master’s Training and Education in Counseling Psychology: An Urgent Concern
Contributing to the ambivalent relationship of counseling psychology to masters training… -Jackson & Scheel, p.676
In some situations, the master’s training programs were developed …to help fund the doctoral training program. -Palmer, p.703
In some cases, master’s programs help pay the bills for doctoral education…in difficult economic times, counseling psychology doctoral programs without master’s programs may be easier to cut -Jackson & Scheel, p. 687 & 688
To maintain CACREP accreditation when budget cuts are required, deans and other administrators…may prioritize master’s over doctoral programs since master’s training is less expensive than doctoral training. -Jackson & Scheel, p.682
The new MCAC accreditation standards may serve to promote a new direction for counseling master’s education…consistent with core values and contributions of counseling psychology -Jackson & Scheel, p. 681
It is questionable…whether we [counseling psychology] will be able to avert eventual professional annihilation…as a profession we are experiencing THE RECKONING -Palmer, p. 701 & 704
DSM-5 -DSM-5 combines Axis I, II, and III -“The multiaxial distinction among Axis I, Axis II, and Axis III disorders does not imply that there are fundamental differences in their conceptualization, that mental disorders are unrelated to physical or biological factors or processes, or that general medical conditions are unrelated to behavioral or psychosocial factors or processes” (APA, 2000) -Primary Diagnosis -The most acute condition that requires the most intensive skilled services
DSM-5 -Contributing psychosocial and environmental factors or other reasons for visits (replaces DSM- IV Axis IV) -Over 130V codes (use Z codes after October 1, 2014) -The V codes can be used when it is more specific to the care being rendered than a psychiatric diagnosis -The DSM-5 includes separate measures of symptom severity and disability for individual disorders (replaces DSM-IV Axis 5) -World Health Organization Disability Assessment Schedule (WHODAS 2.0)
DSM-5 -Autism as a spectrum -impossibly muddled, allowing for multiple interpretations that will lead to inherently inaccurate diagnosis -Criteria A-does not specify how many of its 3 are required
DSM-5 Substance Use Disorders – Abuse and Dependence combined into Use – Read and follow the Recording Procedures and Coding Notes! – Criteria Threshold = 2 of 11 symptoms – Impaired control (criteria 1-4) – Social impairment (criteria 5-7) – Risky use (criteria 8-9) – Pharmacological criteria (criteria 10-11)
DSM-5 Substance Use Disorders – Removed Polysubstance-Related Disorder Specifier for a physiological subtype – Changed On agonist therapy to On maintenance therapy
DSM-5 Disruptive Mood Dysregulation Disorder – Temper/anger outbursts occur three or more times per week – Manifest verbally or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property – Grossly out of proportion in intensity or duration to the situation or provocation and inconsistent with the child’s developmental level – Hallmark symptom is “very severe, non-episodic irritability” (DSM-5, p. 157) Criterion present for at least 12 months and symptoms have not been absent for less than 3 months at a time – “persistent, frequent, extreme”
DSM-5 Disruptive Mood Dysregulation Disorder, con’t Age 6 years or older, onset before 10 years of age; prior to age 18 Mutually exclusive with bipolar, intermittent explosive, PTSD, and oppositional defiant disorders – and it trumps ODD (15%) – But it can coexist with attention-deficit/hyperactivity, conduct disorder, substance use disorder, major depression – “clear-cut changes”
DSM-5 Tools -ACA Webinars ( www.counseling.org) click on Continuing Education scroll to webinarswww.counseling.org -ACA creating a book to assist professionals to utilize DSM V to the fullest
New HIPPA Regulation Duty to warn (technology use) According to Nancy Wheeler, ACA risk management consultant, counselors need to inform clients in consent forms about encrypted emails “covered entity” Updating NPP(Notice of Privacy Practices)
Ward v. Wilbanks A practicum student referred rather than counsel a homosexual client. After due process, the student was dismissed from the counseling program. The student sued the university counseling faculty and officials alleging violation of her 1 st & 14 th amendment rights, including to practice her religious beliefs.
The Judge ruled against the student and for the EMU counseling program ACA has posted the decision at: www.counseling.org/kaplan/EMU.pdf www.counseling.org/kaplan/EMU.pdf
Judge’s Opinion University programs have the right to set standards. There is a “rational basis” to adopt the ACA Code of Ethics into a counselor preparation program. It is reasonable to use CACREP standards in a counselor preparation program.
The case was appealed and sent back to District court ACA filed an amicus brief in support of the original decision www.counseling.org/resources/pdfs/EMUamicusbrief.pdf
Depositions were taken for a January, 2013 trial
An out of court settlement was reached (12/11/12)
Augusta State University lawsuit Keeton v. Anderson-Wiley
The Judge ruled against the student and for the ASU counseling program
“This is not a case pitting Christianity against homosexuality”. Rather, the judge ruled, it is about a university enforcing reasonable standards - the ACA Code of Ethics.
An appeal was denied by the 11 th federal circuit court
And in February an appeal for the circuit court to revisit their decision was denied
Leaves all court rulings to date intact Graduate counseling programs have the right to set standards. There is a “rational basis” to adopt the ACA Code of Ethics into a counselor preparation program. It is reasonable to use CACREP standards in a counselor preparation program.
And…. It continues to be a major violation of the ACA Code of Ethics for a counselor to discriminate against clients on the basis of sexual orientation
State legislative bodies have gotten into the act….
It’s getting personal…language from Michigan SR 66 “Whereas, The American Counseling Association, a private organization that promulgates a code of ethics widely used by university counseling programs and state licensure boards in training for and regulating the counseling profession, has publicly supported universities that have punished or dismissed students for adhering to their sincere religious convictions…”
California recently banned reparative therapy for children
Who is on the ERTF? Jeannette Baca Janelle Disney Perry Francis (Chair) Gary Goodnough Mary Hermann Shannon Hodges Lynn Linde Linda Shaw Shawn Spurgeon Richard Watts Michelle Wade Erin Martz (ACA staff) David Kaplan (ACA staff)
Timeline highlights Task force appointed Summer of 2011 Initial call for member input Fall 2011 Draft composed April 2012-2013 Call for draft feedback May 2013 Draft revised based on input June-December 2013 Final draft presented to ACA Governing Council March 2014
ERTF Areas of Focus Social media The imposition of counselor personal values When is a client a client? Removing the end of life exemption Fee splitting
Major PP&L Issues Affordable Care Act VA hiring of Counselors TRICARE independent practice Medicare
The Other ACA – a lot to like Exchange plans must cover both mental health and substance – use disorders. Coverage must be generally comparable with coverage for medical care. Co-pays for mental health care abolished.
VA (Non-)Hiring of LPMHCs www.usajobs.gov Number of VA social worker positions posted in 2012: 1,563 Number of VA LPMHC positions posted in 2012: 58
ACA Has… Written to VA Secretary Eric Shinseki, and met repeatedly with multiple VA staff Met with White House staff Met with members of Congress, and worked with them to draft letters to the VA
Goals Open up VA paid traineeships to counselors Establish alternative eligibility criteria for LPCs w/o CACREP degrees Have VA central office light a fire under local VA directors to hire more counselors
TRICARE requirements: now through 2014 Licensed counselors must: have a master's or higher-level degree “from a mental health counseling program of education and training”* and either – Pass the NCE or NCMHCE (for CACREP-accredited degrees) OR – Pass the NCMHCE (for regionally-accredited degrees) have 2 years/3,000 hours of supervised clinical practice, "provided by a mental health counselor” * For at least CACREP degrees, this is interpreted by DoD to mean only degrees with the title of “mental health counseling” or “clinical mental health counseling”
TRICARE independent practice requirements: beginning 2015 Licensed counselors must: have a CACREP degree pass the NCMHCE same 2 years/3,000 hours of supervision as previous slide Practice under physician referral and supervision will no longer be allowed.
Medicare The Current Strategy: getting included in the Senate Medicare physician payment reform package
For updates on legislative issues go to the ACA website at www.counseling.org and click on the public policy tab