1. Counselor Education Programs in MA BSAS Approval Process

2. Agenda 9:30Welcome and Introductions 9:45Background, Current Process 10:00Proposed Application and Approval Process Discussion and Feedback 11:15Next Steps

3. Background Workforce Development Efforts  WF & Organizational Development Strategic Plan: Vision  Licensed Alcohol and Drug Counselors (LADCs)  Levels of LADC  Regulations  Legislation  Resources  Careers of Substance website  Trainings  Educational programs

4. Background Licensure of Alcohol and Drug Counselors Regulations 105 CMR 168.000 went into effect in 2004. Developed pursuant to MGL C 111J. Established eligibility requirements, application and renewal process for three levels of licensure: LADC I, LADCII and LADC Assistants. Developed by BSAS and an advisory group, which included: –Substance abuse treatment representatives, –Education providers and –Certifying bodies (including NAADAC, MAADAC and ICRC).

5. Current process to approve education hours Candidates provide evidence of education completed If from an entity already approved for another candidate: approved. If not from previously approved entity: review description, hours, qualifications of educator, method of testing, etc. Informal list of approved entities.

6. Current process to approve education hours To be considered eligible for licensure: LADC I and II must complete 270 hours of approved education and LADC Assistants must complete 50 hours of education. When the regulations went into effect, it was also decided that existing education providers would continue to be recognized through the LADC application approval process.

7. Current process to approve education hours Applicants for initial licensure complete their required 270 hours: Through a comprehensive program run by a single education provider, OR By combining coursework from multiple education providers –May or may not be part of an accredited college or university. –Applicants required to submit evidence of required hours in the form of a transcript or certificate of education.

8. Proposed Approval Process Purpose: To ensure that individuals obtain the necessary rigorous education experience for licensure. The process must be simple and transparent for the licensure applicant, the education provider, and the regulatory body. Current ProcessProposed Process ApplicationNoYes Link to Nat’l StandardsInformalFormal Incorporation of MA Standards InformalFormal Standardized processSomewhatYes

9. National Standards Standards for minimum training and competencies for those entering the field have. Based on a review by the BSAS internal working group, these standards meet or exceed the minimum educational requirements for MA LADC:

10. National Standards NASAC - the National Addictions Studies Accreditation Commission NAADAC, the Association for Addiction Professionals IC&RC - the International Certification & Reciprocity Consortium (refers to state approval processes – MA process under review)

11. Massachusetts Standards BSAS Approved Addiction Education Providers must also prepare students to meet Massachusetts Licensed Alcohol and Drug Counselor regulations.

12. Principles of Care and Practice Guidance Terms and Conditions, Standards of Care, and Management and Operations sections of periodic Request for Response documents Request for Response Program Regulations LADC Regulations Massachusetts Standards

13. BSAS expects the following will be addressed by educational programs, regardless of phrasing differences in national standards: A. Learning Experience Culturally and linguistically appropriate teaching processes should be used. Adult-oriented learning approaches, such as experiential learning, should be used. Quality Clinical Supervision should be provided for any practicum.

14. B. General Content Requirements Addiction should be covered comprehensively, including both process and substance addictions. All stages of substance use should be covered including abstinence, use, abuse, and dependence. Addiction should be approached as a chronic disease which is treatable, and for which effective treatment attends to the multiple needs of an individual and family. Educational content should be continuously updated and based on current science and research Evidence Based Practices in Prevention and Treatment must be included, as well as ways to keep up on new techniques. For example, Motivational Interviewing is a widely adopted evidence- based practice which is supported by BSAS. Adaptations of techniques for particular populations should be taught. Prevention and Treatment should be approached as collaborative activities. Massachusetts Standards

15. C. Specific Content Requirements 1.Ethics and Boundaries, Consumer/Client Rights: Students should be familiar with BSAS counselor licensure regulations, and the Ethical Standards for Counselors per 105 CMR 168.023, as well as the rights of consumers/clients.regulationsEthical Standards for Counselors 2.Culture and Special Populations: In providing education about addictions in special populations, there should be explicit discussion about cultural responsiveness to individual clients and equity in access and outcomes. This should happen not only in terms of race and ethnicity, but also heritage, disability, gender identity, sexual orientation, economic and social class, homelessness, criminal justice involvement, age and developmental process. Reference should be made to the National Standards for Culturally and Linguistically Appropriate Services, DPH’s CLAS initiative and the Making CLAS Happen manual, along with related BSAS- sponsored trainings.Culturally and Linguistically Appropriate ServicesCLAS initiativeMaking CLAS Happen manual

16. Massachusetts Standards 3.Self-help: Integration of 12-step and other self-help groups in the recovery process. 4.Medication: Medication-assisted addiction treatment (methadone and Suboxone) and other commonly prescribed mental health medications. 5.Trauma: Students should have a clear understanding of Trauma-Informed approaches to care. 6.Family Issues/Involvement: Information about familial cycles of addiction, theories of attachment, reference to the Adverse Childhood Experiences study, effects of substance abuse and addictions on children and other family members, as well as how families can intervene in a person’s addiction and play a positive role in their recovery.Adverse Childhood Experiences

17. Massachusetts Standards 7.Behavior management: Understanding the meaning behind typical client behaviors and responding appropriately, using methods such as Motivational Interviewing techniques. 8.Co-occurring conditions: Mental health and physical health conditions co-occurring with addiction. 9.Infectious Disease: Understanding the interplay of addiction and infectious diseases, including HIV/AIDS, viral hepatitis, sexually transmitted infections (STIs), tuberculosis, and others. 10.Outreach, Prevention and Early Intervention: Information about Harm/Risk Reduction, Universal, Selective and Indicated interventions, and selection of strategies.

18. Massachusetts Standards 11.Integrated Care: Integration of treatment for behavioral and physical health conditions, including pregnancy. 12.Quality: Process improvement techniques, such as those used by NIATx (formerly the Network for the Improvement of Addiction Treatment), methods of incorporating consumer input, data collection and interpretation primarily for the purposes of outcomes measurement.NIATx 13.Safety: The importance of ensuring physical safety (related in part to behavior management) and emotional safety (related to being Trauma Informed) for staff and clients. 14.Self-care: Information and resources related to secondary trauma and professional self-care.

19. Massachusetts Standards 15.Culture of Recovery: Understanding that recovery exists on a continuum, building on the positive notion that recovery is possible and achievable; include concepts such as “recovery capital” and peer supports. 16.Responses to relapse: Relapse should be approached as a part of recovery, and relapse prevention and constructive relapse responses should be taught. 17.Holistic and nutritional approaches to recovery: Students should be aware of holistic approaches such as mindfulness, acupuncture, good nutrition, physical exercise, etc. 18.Tobacco: Tobacco use, prevention and cessation should be included in the curriculum

20. Massachusetts Standards 19.BSAS Levels of Care: Students should be familiar with the BSAS Levels of Care (beginning on p. 42 of the Program Regulations), the methods and goals of each level of care, and how a person may enter, flow through, exit and return to the system. Program Regulations 20.Developmental Stages: Treatment responses which are appropriate for different developmental stages. 21.Compulsive Gambling: Understanding how gambling and other process addictions relate to substance use and can exist as a primary addiction. 22.Pharmacology/Neurobiology: Descriptive and up-to- date information about common drugs of abuse, and how they interact with and effect users’ bodies and brains.

21. Application Review and Discussion

22. Next Steps Application revisions Feedback period Application roll-out Advisory Group –Review and provide feedback on revised approval process –Partner with peers and BSAS to look at trends, needed adjustments to curricula –Commitment: participate in discussions, act as a sounding board, meet at least twice/year, respond to requests for feedback in a timely manner

23. Further questions, thoughts, recommendations? Contact: Jen Parks Workforce Development and Training Coordinator DPH - Bureau of Substance Abuse Services 617-624-5134 jennifer.f.parks@state.ma.us